Revision total hip arthroplasty with custom-made hip implant for Paprosky type IV femoral bone loss

Introduction Replacement of extensive Paprosky type IIIB and type IV bone loss is a challenge in revision total hip arthroplasty (THA).The purpose was to demonstrate the possibility of femoral reconstruction in proximal femur bone loss using a custom-made implant for revision THA.Material and methods We report a case of a 72-year-old patient with an extensive Paprosky type IV femoral defect, which was replaced using a custom-made modular component.Results The femoral defect was successfully augmented with a custom-made modular component, and the hip function was restored. The locking mechanism of the constrained system failed at 6 months with the joint remained stable. The patient could ambulate with additional support. VAS, HHS and HOOS scores measured before and after 2 years showed positive dynamics.Discussion Paprosky type IIIB and type IV defects are a challenge for revision hip arthroplasty. There is a variety of surgical options with outcomes being ambiguous. Modular and monoblock tapered stems, the technique of impacted bone graft have been reported to have excellent results in revision THA with Paprosky type III and IV defects. A custom-made femoral component was developed based on the principle of modular stems. Joint stability is a concomitant problem with a severe bone defect that can be addressed with a double mobility or constrained system. Both methods are associated with a sufficient number of complications.Conclusion Replacement of a Paprosky type IV femoral defect with a custom-made modular component demonstrated satisfactory outcomes at a two-year follow-up. The patient had no complaints, could ambulate unassisted using an elbow crutch and positively evaluated the result of treatment.