Conservative Femoral Revision: A position Paper and Treatment Framework

ABSTRACT
Background: With overall numbers of hip revisions on the increase in the Asia Pacific and patients undergoing surgery there is
a growing need to perform more conservative surgery. Surgeons need to plan for further surgeries in the future. This paper aims to
describe a conservative approach and hopefully reduce this future burden.
Methods: To address these issues a consensus group was formed to discuss the revision trends across various countries within
the Asia Pacific region. The results of this discussion were used to formulate a framework for how surgery could be planned and
what implants would allow more preservation of femoral bone and hopefully allow more straight forward re-revision surgery if
required in the future.
Results: The group felt in femoral revision cases of Paprosky 2a or less many can be managed with minimal bone loss. If possible,
Metaphyseal loading implants can be used with or without osteotomy to preserve distal bone for the future. Where possible cement
in cement techniques can be used to avoid more distal bone loss. Distal fitting or endoprosthesis implants should be reserved for
2b cases with severe bone loss.
Conclusion: There is an increasing demand for revision surgery, and more patients may require multiple revision surgeries.
When planning for revision surgery there is a need to consider and plan for the next revision in the future. The aim of conservative
hip revision should focus on protecting bone stock for future treatment whilst reducing the risk of re-revision.