Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur

Abstract

BackgroundThe transfemoral and the extended trochanteric osteotomies are the most common osteotomies used in femoral revision, both when proximal or diaphyseal fixation of the new component has been decided. We present an alternative approach to the trochanteric osteotomies, most frequently used with distally fixated stems, to overcome their shortcomings of osteotomy migration and nonunion, but, most of all, the uncontrollable fragmentation of the femur.MethodsThe procedure includes a complete circular femoral osteotomy just below the stem tip to prevent distal fracture propagation and a subsequent preplanned segmentation of the proximal femur for better exposure and fast removal of the old prosthesis. The bone fragments are reattached with cerclage wires to the revision prosthesis, which is safely anchored distally. A modified posterolateral approach is used, as the preservation of the continuity of the abductors, the greater trochanter, and the vastus lateralis is a prerequisite.ResultsBetween 2006 and 2012, 47 stems (33 women, 14 men, mean age 68 years, range 39–88 years) were revised using this technique. They were 12 (26%) stable and 35 (74%) loose prostheses and were all revised to tapered, fluted, grit-blasted stems. No fracture of the trochanters or the distal femur occurred intraoperatively. Mean follow-up was 28 months (range 6–70 months). No case of trochanteric migration or nonunion of the osteotomies was recorded. Restoration of the preexisting bone defects occurred in 83% of the patients. Three patients required repeat revision due to dislocation and one due to a postoperative periprosthetic fracture. None of the failures was attributed to the procedure itself.ConclusionsThis new osteotomy technique may seem aggressive at first, but, at least in our hands, has effectively increased the speed of the femoral revision, particularly for the most difficult well-fixed components, but not at the expense of safety.

Mid-term results of revision total hip arthroplasty with an uncemented modular femoral component

“…Complications of the endofemoral approach include: iatrogenic fracture; poor positioning of the revision stem; 3-point fixation; and incomplete removal of cement (17). Other potential adverse events of femoral osteotomy include nonunion or proximal migration of the osteotomy fragment (26, 27), and intraoperative split fractures of the dorsal portion (27, 28), which can compromise fixation of the revision stem (26). In the present series, we did not observe significant morbidity related to the femoral osteotomy.…”

Development of the Revision Hip Complexity Classification using a modified Delphi technique

“…During the open meeting, we presented data on a number of different techniques of stem removal and outcomes based on a review of literature. 11 - 13 The literature is limited in this regard and might therefore explain why we only achieved a simple majority vote for this type of case. We also had an extensive discussion with regard to UCS classification grades B1, C, and D for periprosthetic fracture.…”

Treatment of Prosthetic Joint Infection due to Listeria Monocytogenes. A Comprehensive Literature Review and a Case of Total Hip Arthroplasty Infection

“…2 a and b). At the first stage, we removed the stem using controlled segmentation of the well-fixed part of the stem according to Megas et al [ 21 ]; the mobile part and the screws were removed, and a mobile-bearing spacer (Zimmer-Biomet, Warsaw, Indiana) was used ( Fig. 3 a and b).…”