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

Abstract

Background The transfemoral approach is an extensile surgical approach that is performed routinely to facilitate cement and implant removal and improve exposure for revision stem implantation. Previous studies have looked at clinical results of small patient groups. The factors associated with fixation failure of cementless revision stems when using this approach have not been examined. Questions/purposes We determined (1) the clinical results and (2) complications of the transfemoral approach and (3) factors associated with fixation failure of revision stems when using the transfemoral approach. Patients and Methods We retrospectively examined all our patients in whom femoral stem revision was performed through a transfemoral approach between December 1998 and April 2004 and for whom a minimal followup of 2 years was available. One hundred patients were available for this study. The mean (± SD) postoperative followup was 5 years (± 1.64 years). Results The average Harris hip score improved from 45.2 (± 14.02) preoperatively to 83.4 (± 11.86) at final followup. Complete radiographic bony consolidation of the osteotomy site was observed in 95% of patients. Dislocations occurred in 9% of patients. Four revision stem fixation failures were observed, all occurring in patients with primary three-point fixation. Three-point fixation was associated with short osteotomy flaps and long revision stems. Conclusions The transfemoral approach is associated with a high rate of osteotomy flap bony healing and good clinical results. When using the transfemoral approach, a long osteotomy flap should be performed and the shortest possible revision stem should be implanted.

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement

“…Alterations in the gluteal musculature as a result of previous surgery is reflected in the greater proportion of pre-operative positive Trendelenburg signs in the transfemoral group (Table III). A study by de Menezes et al 30 involving 100 straight Revitan revision stems implanted via transfemoral approach with a mean follow-up of five years, showed a similar mean HHS (83.4) to that of our study (85.9).…”

“…Either the fixation bed for the prosthesis is prepared with a cylindrical reamer alone (Brehm-MRP-Schaft, Profemur-R-Schaft) and results in cone-in-cylinder fixation; or the medullary cavity is first reamed with a cylindrical tool and then cone-in-cone fixation is obtained with a conical rasp (Revitan Curved). 4,6,28 In a study of 100 Revitan straight stems which had been introduced via the transfemoral approach, de Menezes et al 30 shorter stems with cone-in-cone fixation in the head of the distal component in the isthmus of the femur result in a lower incidence of subsidence than longer stems with more proximal fixation. They recommended the use of stems that were as short as possible while enabling distal fixation at the intact femoral isthmus.…”

Trochanteric osteotomy in revision total hip arthroplasty

“…While most hips in this series (54%, 37/68) were performed for aseptic loosening, it is notable that 21% (14/68) of cases involved a periprosthetic fracture. De Menezes et al 33 reported a similar improvement in Harris Hip Scores, from 45.2 points (standard deviation 14.02 points) pre-operatively to 83.4 points (standard deviation 11.86 points) at final follow-up of five years (standard deviation 1.64 years) in their series of 100 patients undergoing aseptic revisions. 33 Causes for revision THA in this series included aseptic femoral component loosening (40%, 40/100) and revision of an acetabular component for aseptic loosening (30%, 30/100) among other aseptic causes.…”

Bone density and functional results after femoral revision with a cementless press-fit stem

“…All the quantitative radiographic measurements were taken using EvalNet software (LeadTools TM ; LEAD Technologies, Inc., Charlotte, NC, USA), with the precision confirmed beforehand [9].…”