Management bone loss of the proximal femur in revision hip arthroplasty: Update on reconstructive options

Table 1 Algorithmic approach of proximal femur reconstruction according to Paprosky classification

Type	Description	Treatment option
I	Minimal metaphyseal cancellous bone loss Intact diaphysis	Cementless or cemented primary stems with common length and geometry
II	More extensive cancellous bone loss including the whole metaphysis down to the level of the lesser trochanter	Proximally fixed stem (usually modular) Calcar replacement stem if medial cortex of the femoral neck is compromised
IIIA	Extensive metaphyseal and diaphyseal bone loss of the femur; More than 4 cm of diaphyseal bone are available for distal fixation of cementless stem	Cementless stems with distal (diaphyseal) Extensively porous coated stems Modular stems fluted distally and porous coated proximally
IIIB	Available diaphyseal bone is less than 4 cm in length	Extensively porous-coated stems Impaction grafting + cemented stem Modular cementless tapered fluted stem
IV	Widened diaphysis that provides no support for cementless fixation	Impaction grafting + cemented stem Allograft prosthetic composite Tumor megaprosthesis