Rapid progression of a severe femoral bone loss in a stable revision hip prosthesis: causes and management

We report a case of a severe bone loss of the proximal fe mur with a rapid progression, in a 72-year-old male patient with a stable total revision hip prosthesis. The pa tient had a persistent mechanical thigh pain. The blood laboratory values were normal. Infection disease and osteolytic bone tumor were excluded. A surgical procedure was performed. The native bone of the proximal femur was resorbed and replaced by a dense fibrous tissue with some sclerotic bone fragments. A large amount of a brownish fluid and a red-brown and friable tissue were found in the pseudojoint cavity. The proximal femur was reconstructed using a large amount of cryopreserved cancellous bone allograft, with retention of the femoral prosthesis. The mechanism of the bone lesion can be related not only to the host response to the wear particles, but mainly to the fluid pressure in the effective joint space. Femoral progressive osteolysis in a stable hip prosthesis is an indication for surgery in useful time, before adverse bone remodeling can begin and lead to major bone loss.