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Modified transfemoral approach to revision arthroplasty with uncemented modular revision stems.
- Source :
-
Operative Orthopadie und Traumatologie [Oper Orthop Traumatol] 2007 Mar; Vol. 19 (1), pp. 32-55. - Publication Year :
- 2007
-
Abstract
- Objective: Removal of a loose or fractured stem in total hip arthroplasty. Implantation and secure fixation of a modular uncemented revision stem to restore painless joint function.<br />Indications: Loose and/or broken prosthetic stem. Risk of intraoperative fracture or perforation of the femur when stem revision becomes unavoidable. Periprosthetic fracture.<br />Contraindications: Loose prosthetic stems that can be revised without the risk of perforation or fracture of the femur. Interprosthetic femoral fractures between the ends of hip and knee prosthetic stems that require total replacement of the femur.<br />Surgical Technique: Exposure of the femur anterior to the lateral lip of the linea aspera in the lateral intermuscular septum. 3.2-mm drill holes are made at the anterior and posterior ends of the planned bone flap. Osteotomy of the femur anterior to the junction of the vastus lateralis and the gluteus medius muscles. Posterior osteotomy as well as distal transverse osteotomy between the drill holes and distal anterior osteotomy. The anterior osteotomy is performed using a chisel passed under the vastus lateralis from distal to proximal at the anterior aspect. The osteotomized lateral femoral bone flap with muscle attachment is folded back. Implantation of a modular uncemented revision stem and fixation of the bone flap with double cerclage.<br />Postoperative Management: Thrombosis prophylaxis, physiotherapy, gait training with partial loading of the limb at 10 kg for a period of 6 weeks with hip flexion limited to 70 degrees. Then, free range of movement and increased loading by 10 kg per week.<br />Results: 74 modular uncemented revision stems were implanted in transfemoral technique and the outcomes clinically and radiologically analyzed over an average follow-up period of 20.2 +/- 12.1 months (10-43 months). The Harris Hip Score increased from a preoperative value of 42.21 to 85.97 points after 2 years. Subsidence was observed for four stems and early loosening for two stems. The press-fit anchorage of these latter two stems was < 3 cm.
- Subjects :
- Adult
Aged
Aged, 80 and over
Bone Cements
Female
Humans
In Vitro Techniques
Male
Middle Aged
Reoperation instrumentation
Reoperation methods
Treatment Outcome
Arthroplasty, Replacement, Hip instrumentation
Arthroplasty, Replacement, Hip methods
Femur Head surgery
Hip Prosthesis
Osteotomy instrumentation
Osteotomy methods
Prosthesis Failure
Subjects
Details
- Language :
- English
- ISSN :
- 0934-6694
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Operative Orthopadie und Traumatologie
- Publication Type :
- Academic Journal
- Accession number :
- 17345026
- Full Text :
- https://doi.org/10.1007/s00064-007-1194-6