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Clinical Orthopaedics and Related Research®

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01-03-2012 | Clinical Research

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

Authors: Daniel F. A. de Menezes, MD, Pierre Le Béguec, MD, Hans-Peter Sieber, MD, Mathias Goldschild, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2012

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.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Stem and Osteotomy Length are Critical for Success of the Transfemoral Approach and Cementless Stem Revision
Authors: Daniel F. A. de Menezes, MD
Pierre Le Béguec, MD
Hans-Peter Sieber, MD
Mathias Goldschild, MD
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 3/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1998-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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