[Procedure in extensive or complete loss of bone substance of the femur following shaft loosening].

We reviewed our present method of treatment in cases of femoral bone loss. Our clinical experience with the method is based on 800 exchange operations performed at the Endo-Klinik per year. The review showed that in cases of proximal bone deficiency, custom-made protheses are increasingly required. Cemented implants are used in septic and aseptic cases but we also have had experience with a small number of cases in which reconstructive surgery was carried out using allografts and cementless shaft components. In 1.4% of revision cases total femoral replacement is required. We have had more than 12 years experience with this type of prostheses, which is available as a modular system. So far there has been no disarticulation as a result of implant failures but in some instances failure occurred due to persistent deep infections.