Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur
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RESEARCH ARTICLE
Open Access
Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur Panagiotis Megas*, Christos S Georgiou, Andreas Panagopoulos and Antonis Kouzelis
Abstract Background: The 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. Methods: The 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. Results: Between 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. Conclusions: This 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. Keywords: Proximal femur segmentation technique, Femoral osteotomy, Stem removal, Wagner revision stem, Hip revision arthroplasty, Surgical technique
Introduction The transfemoral osteotomy described by Wagner [1] and the extended trochanteric osteotomy (ETO) popularized by Younger et al. [2] are the most commonly used in femoral revision, both when proximal or diaphyseal fixation of the new component has been decided [3,4]. These trochanteric osteotomies involve the creation of a longitudinal bone flap of various dimensions * Correspondence: [email protected] Department of Adult Reconstructive Surgery, Patras University Hospital, Patras, Greece
at the anterolateral femur, with the surrounding musculature remaining attached. They provide increased exposure of the fixation surfaces and adequate access to the canal for reaming and prosthesis insertion
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