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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.