Hip arthroplasty with an extended femoral stem for salvage procedures.

The problem of treatment of a combination of failed hip arthroplasty secondary to resorption, osteoporosis, osteolysis, or fracture is unsolved. Twenty-seven such complicated hips, including four with previous infection, were treated by a femoral prosthesis driven into an intramedullary nail. The goal of stability, allowing immediate mobilization, was attained in virtually all patients. The oldest was 84 years of age and the mean age was 69.3 years. In the early postoperative period, one patient died of pulmonary embolism and one of myocardial infarction. Two infections were treated 25 and 11 months after implantation; these patients were free from pain and showed no signs of loosening of the implant. The mean time in the hospital for the infected patients was 60 days and for the noninfected patients was 23 days. Among 14 patients who were observed for at least ten months after surgery, freedom from pain was achieved in eight, significant alleviation of pain in five, and slight improvement in one. Five patients also became completely free from dependence on walking aids; seven used one or two canes. Two patients were dependent on crutches. Discrepancy in the length of the lower limbs was noted in seven patients. Six patients showed 1 cm shortening and one patient 2 cm. In six patients the Trendelenburg sign was negative, and in only three patients was it clearly positive. The mean Harris Hip Score in 14 patients observed for more than ten months after surgery was 82. Intramedullary nailing combined with a femoral component in total hip arthroplasties, where defects or fractures of the femur have occurred, give good fixation of the implant components and a satisfactory functional result.