Proximal Femoral Replacement in Birmingham
A modular megaprosthesis that reconstructs the upper femur and hip joint when bone loss from fracture, osteolysis, or failed revision surgery is too severe for standard revision stems. Mr Hussain performs PFR for orthopaedic indications at the Royal Orthopaedic Hospital Birmingham.
Total procedures
498 verified reviews
ENDO-Klinik Hamburg
Overview
What Is Proximal Femoral Replacement?
Proximal femoral replacement (PFR) is a modular megaprosthesis that replaces the upper femur and hip joint when bone loss is too severe for a standard revision hip replacement stem to achieve adequate fixation. A conventional revision stem requires a minimum length of intact diaphyseal bone distal to the defect; when this is not available, a PFR bridges the gap by replacing the entire proximal femoral segment with a metal implant that attaches directly to the remaining diaphysis.
PFR in Mr Hussain's practice is performed exclusively for orthopaedic indications, not oncology (tumour) surgery. While the implant design bears similarities to those used in limb-salvage tumour surgery, the clinical context is entirely different. Mr Hussain treats patients with severe bone loss from periprosthetic fractures, osteolysis, or multiple failed revisions. He does not perform orthopaedic oncology surgery.
PFR is one of the most complex procedures in revision arthroplasty. It requires a surgeon with specialist experience in both implant selection and soft tissue reconstruction, particularly of the abductor mechanism, which is critical for stable walking. Mr Hussain's subspecialty fellowship at ENDO-Klinik Hamburg, one of the world's highest-volume revision centres, provides this experience.
Indications
When Is Proximal Femoral Replacement Needed?
PFR is reserved for situations where the proximal femoral bone stock cannot provide adequate fixation for a standard long-bypass revision stem. The decision is made based on pre-operative CT planning and confirmed intraoperatively.
Vancouver C and Extensive Periprosthetic Fractures
Periprosthetic fractures classified as Vancouver C extend well below the tip of the existing stem, into the distal femoral diaphysis. In some of these cases the fracture is too comminuted, too extensive, or associated with too much bone loss to allow fixation with internal fixation alone or a long bypass stem. When adequate distal fixation cannot be achieved with a standard stem, a PFR provides secure reconstruction by attaching to remaining healthy diaphyseal bone further distally.
Massive Proximal Femoral Osteolysis
Osteolysis caused by wear particle-induced inflammatory bone destruction can devastate the proximal femur over years, destroying the cancellous bone and progressively thinning the cortex. In severe cases, the Paprosky classification identifies femoral defects so extensive that no standard revision stem can achieve stable biological fixation. A PFR provides immediate mechanical stability without dependence on the destroyed proximal femoral bone for support.
Multiple Failed Revision Surgeries
Each revision hip replacement carries a risk of further bone loss, both from the procedure itself (cement removal, reaming) and from ongoing osteolysis or infection. After two or three previous revision operations, the proximal femoral bone stock may be so depleted that standard revision stems cannot achieve fixation. PFR allows reconstruction even when the proximal femur is no longer a viable mechanical structure, using the intact mid-diaphysis for distal fixation.
Severe Bone Loss at First Revision
Occasionally, the first revision of a hip replacement encounters bone loss so severe that standard reconstruction options are not viable intraoperatively. This may occur when an implant has been in situ for many years with longstanding osteolysis that has not previously been detected, or when infection has caused extensive bone destruction. In these situations, PFR may be required even for a first revision procedure.
The Operation
The PFR Procedure
PFR is a complex, high-stakes operation requiring thorough pre-operative planning, an experienced surgical team, and full access to the range of modular megaprosthesis sizes. CT-based templating is performed before surgery to select the appropriate implant length, diameter, and configuration.
Intraoperatively, all failed implant components and any cement are removed. The proximal femoral bone that cannot provide structural support is excised, and the distal cut is made at a level of healthy cortical bone where the megaprosthesis stem can achieve stable press-fit or cemented fixation. The modular megaprosthesis is assembled and implanted, with a femoral head and acetabular component completing the hip joint reconstruction.
A critical and technically demanding part of PFR is the reconstruction of the abductor mechanism. The gluteus medius and minimus muscles, which normally attach to the greater trochanter, must be reattached to the proximal segment of the megaprosthesis. The prosthesis carries a dedicated soft tissue attachment mechanism (typically a porous-coated or trochanteric collar) to allow this. The quality of abductor reconstruction strongly influences post-operative stability and the degree of any Trendelenburg limp.
- Modular implant system allows intraoperative adjustment of length and head position
- Distal fixation in healthy diaphyseal bone bypasses all proximal defects
- Abductor mechanism reconstruction is a critical determinant of functional outcome
- Dual mobility or constrained cup used routinely to minimise dislocation risk
- High-dependency care available post-operatively for complex cases
After Surgery
Recovery After Proximal Femoral Replacement
Recovery from PFR is longer and more demanding than after a standard revision hip replacement, reflecting the extent of the reconstruction. Realistic expectations are important from the outset.
Early Mobilisation with Support
Physiotherapy begins the day after surgery. Initial mobilisation is with a frame or crutches, with weight-bearing guided by the stability of the abductor repair and the distal fixation achieved. Some patients begin with toe-touch or partial weight-bearing; others may be allowed full weight-bearing from the outset, depending on intraoperative findings.
Protected Weight-Bearing and Abductor Rehabilitation
The abductor mechanism repair requires time to heal and consolidate. During this period, physiotherapy focuses on gentle hip abductor strengthening exercises, range of movement, and progressive weight-bearing as tolerated. Hip dislocation precautions are maintained. Most patients continue with two crutches during this phase.
Progressive Strengthening and Function
As abductor strength improves, crutches are progressively reduced. Walking aids may be required beyond 12 weeks in patients with more extensive abductor damage. Hydrotherapy is beneficial at this stage, allowing early progressive loading with reduced gravitational demand.
Consolidation and Return to Function
Most patients achieve their best functional result between 3 and 6 months. Pain relief is typically excellent, and most patients achieve meaningful improvement in mobility. A mild Trendelenburg limp may persist if the abductor mechanism cannot be fully restored to normal tension and function. The goal is independence in daily activities, comfortable walking with or without a stick, and freedom from the pain that prompted surgery.
Revision Surgery in Birmingham
Why Choose Mr Hussain for Revision Surgery?
Mr Hussain holds a subspecialty fellowship from ENDO-Klinik Hamburg, one of the world's leading centres for revision arthroplasty, and has contributed 33 peer-reviewed publications to the orthopaedic literature. His practice at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, and Harborne Hospital is built on a foundation of 5,000+ procedures and a Doctify rating of 4.98 from 498 verified reviews.
Patient Questions
Frequently Asked Questions
Ready to Discuss Your Revision Surgery?
Book a private consultation with Mr Hussain at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, or Harborne Hospital.