AORI | Bone quality | Treatment option |
---|---|---|
F1-T1 | Good (G) | • < 5 mm (< 50% of bone surface area)➔Cement and morselized bone • 5–10 mm➔Cement and screw or morselized bone |
Sclerotic (S) or osteoporotic (O) | • Be sure to obtain adequate zone 3 (diaphysis) fixation • If very sclerotic bone, consider small tantalum cone (disadvantage is to sacrifice bone stock | |
F2A-T2A | Good (G) | • 5–10 mm➔Cement and screw only if low demand patients • > 5 mm; > 40% of surface unsupported from host bone➔Metal augments or structural allograft or impaction bone grafting (young patients) • Need for adequate zone 3 fixation (stems) |
Sclerotic (S) or osteoporotic (O) | • Same option than before • Adequate zone 2 fixation (cone) strongly recommended to reduce risk for aseptic loosening | |
F2B-T2B or type 3 defect | Good (G) | • Impaction bone grafting (young patients), metal augments, structural allograft • Larger defect➔tantalum cone and titanium sleeve with short to medium-length stems • Severe type 3 defect➔mega prosthesis |
Sclerotic (S) or osteoporotic (O) | • Same option than before • Tantalum cone is often required to contemporarily treat bone loss and to enhance zone 2 fixation |