A Modified Transfemoral Approach Using Modular Cementless Revision Stems

Abstract

The transfemoral approach in its traditional form, using a nonmodular Wagner self-locking revision stem, has the disadvantages of a less predictable union rate of the bony flap and a high rate of stem subsidence. To investigate whether this situation can be improved by using a modified transfemoral approach and modular curved cementless revision stems, we prospectively analyzed 68 hip revisions and followed them clinically and radiographically for a minimum of 24 months (mean +/- standard deviation, 32.4 +/- 11.2 months). One year after the operation, the osteotomy showed bony consolidation in all but one case (98.5%). We noted subsidence in six cases (8.8%) and two of these stems became loose. In all of these cases, the circular fixation zone of the stem in the isthmus of the femur was less than 3 cm. The Harris hip score improved continuously from 41.4 +/- 14.5 points preoperatively to 85.9 +/- 14.6 points 24 months postoperatively. The modified transfemoral approach in combination with a curved, modular revision stem showed reproducibly good results concerning union of the bony flap and subsidence of the stem if the fixation zone was not less than 3 cm.

Stem and Osteotomy Length are Critical for Success of the Transfemoral Approach and Cementless Stem Revision

“…Others have described similar high union rates [8,10,12,26]. A slightly higher consolidation rate (98.5%) of the osteotomy flap with the transfemoral approach was described in a study on the transfemoral osteotomy using a curved modular revision stem [6]. The authors of that study postulated the fixation of the bony flap with cerclage wires led to improved results when compared with the traditional Wagner transfemoral approach where suture-supported readaptation of the bony flap was performed.…”

“…One of the approaches to circumvent such problems is the transfemoral approach [6,18,26]. In this study, we report the clinical results and complications of the transfemoral approach and the factors associated with fixation failure of the cementless modular straight revision stem implanted through a transfemoral approach.…”

“…This broader osteotomy of the transfemoral approach has been postulated to be advantageous in the implantation of a cementless revision stem with a diaphyseal mode of fixation [6,18,26].…”

Two-stage Cementless Revision of Infected Hip Endoprostheses

“…The prostheses implanted by the transfemoral approach had a circular fixation zone in the femoral isthmus of 4.1 ± 1.1 cm (range, 1.5-5.5 cm). In three patients in whom the distal circular fixation zone in the isthmus was less than 3 cm owing to destruction or widening of the isthmus, we used static distal interlocking of the stem to improve distal fixation [18]. This involved insertion of three locking screws after implantation of the distal Revitan 1 component using the implantation alignment guide.…”

“…The infected prosthetic stem was removed by the transfemoral approach with a modified extended trochanteric osteotomy in 15 patients, in five because of deformity of the femur and use of a corrective osteotomy, in six because of cement extending distally in the femoral canal, in three because of well-fixed cementless stems with a large-pore surface, in three because of thin bone with a risk of fracture, and in six because of concomitant plate osteosynthesis treatment of a periprosthetic fracture (Fig. 2) [18,19]. Once the spacer implantation had been completed, the extended trochanteric osteotomy was fixed with double cerclage wires.…”