Proximal femoral replacement with locking plate for massive bone loss: a case report

Complications on the femoral side after performing proximal femoral replacement (PFR), such as stem loosening and periprosthetic fractures, are the major reasons for reoperation. Femoral reconstruction was performed using PFR with a locking plate to minimize the risk of complications. We present the case of an 85-year-old woman with stem loosening and massive proximal femoral bone loss (Paprosky type IV) 10 years after stem revision in bipolar hemiarthroplasty. Femoral reconstruction was performed using the following surgical techniques. After removing the previous implant, a PFR was inserted into the host bone of the distal femur and fixed at the junction with cement. In addition, a locking plate was used for bridging. Full weight-bearing rehabilitation was started the day after surgery. At the 5-year follow-up, the patient could walk steadily without complications. A postoperative radiograph of the femur showed no signs of a radiolucent line, implant-related issues, or bone resorption. This reconstructive technique may reduce the high torsional and compressive stresses on bone cement prostheses, which can cause complications on the femoral side. Even in the case of poor femoral host bone quality, this reconstruction method can achieve robust femoral reconstruction. Femorl reconstruction using PFR with a locking plate is a particularly beneficial reconstruction method for older patients with massive proximal femoral bone loss.