Hip revision arthroplasty. Approach to the femoral side

Total hip arthroplasty has proven to be a highly successful procedure but with its increased use in elderly patients and in young patients with high physical demands, there are an increasing number of joints requiring revision. Many factors, including loss of bone stock, joint instability, infection, fracture, trochanteric nonunion, and difficulty in implant or cement removal, make revision of the femoral component challenging to the surgeon. To address these factors and to achieve the goals of revision surgery, several key questions should be addressed. What exposure should be used? How can the implant be removed? What type of reconstruction should be used and which implant should be chosen? How can stable fixation be achieved? How can the bone defects be treated? The approach that the authors recommend to the femoral component in revision hip arthroplasty is outlined, taking into consideration each of the questions above. The classification system used by the authors for femoral bone defects present at the time of revision arthroplasty has four categories based on the integrity of the proximal cancellous bone and the cortical tube, which is used to select the technique of reconstruction. The literature on techniques for revision of a failed femoral component is reviewed.