Revision Femoral Component Arthroplasty

See: Total Hip Replacement Menu:
revision arthroplasty menu

Femoral Revision

exposure of femur

• it is essential that prior to attempted femoral component removal, that there is a clear retrograde path for stem removal;
• this means that any trochanteric overhang is removed, either with a high speed bur or with an trochanteric osteotomy:
• some recommend routine trochanteric osteotomy;

removal of femoral component: (trochanteric osteotomy)

• removal of broken femoral stems:
• removal of cementless stems:
• removal of cemented femoral stems:
• femoral windowing:
  • indications:
    • presence of a large cortical pedestal which lies at the stem tip;
    • large cement column;
    • varus stem position;
  • technique:
    • motorized burr is used to make a longitudinal window over the area of difficulty;
• references:
  • Controlled perforation: A safe method of cement removal from the femoral canal.
  • The window technique for the removal of broken femoral stems in total hip arthroplasty.
  • Femoral windows in revision total hip arthroplasty.
  • Component removal in revision total hip arthroplasty.

reaming

• often long curved femoral stems are required, in which case flexible reamers are needed;
• careful to avoid eccentric reaming;

reconstruction of femoral bone defects

• references:
  • Revision total hip arthroplasty with osseous allograft reconstruction. A clinical and roentgenographic analysis.
  • Freeze-dried proximal femur allografts in revision total hip arthroplasty. A preliminary report.
  • Iontophoresed segmental allografts in revision arthroplasty for infection.
  • Preparation of the proximal femur in cementless total hip revision.

femoral component insertion

• cementless femoral revision:
• cemented femoral revision:

complications

• femur fracture
• references:
  • Intraoperative Complications of Revision Hip Arthroplasty Using a Porous-Coated, Distally Slotted, Fluted Femoral Stem.
  • Femoral Artery and Vein Injury After Cerclage Wiring of the Femur: A Case Report.

• Revision total hip arthroplasty
• Long-term results of revision total hip replacement. A follow-up report.
• Multiple revisions for failed total hip arthroplasty not associated with infection.
• Preparation of the proximal femur in cementless total hip revision.
• The Fate of Well Fixed Cemented Femoral Components Left in Place at the Time of Revision of the Acetabular Component. 
• Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up.
• Revision surgery for failed, nonseptic total hip arthroplasty: the femoral side.