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MIÉRCOLES / WEDNESDAY
88
REVISION STRATEGY AT
THE FEMORAL LEVEL
Laurent Sedel
Hôpital Lariboisiere (APHP) and University
of Paris (France)
Femoral revision is frequent, due to femoral loosening , thigh
pain, recurrent dislocation, osteolysis or sepsis. Whatever
the reason, with the exception of some difficult septic cases,
our strategic approach is similar. Some of our expertise concern
femoral stem retrieval. Our reconstruction strategy is
different if we are revising total hip in active and young patient
or if it is an old and inactive one.
First step is always a large “en bloc” tissue excision. For old
and inactive, it is sometimes possible to retain the stem if
not loosened and perform an “in cement” cementation; In
this group we select usually metal or alumina on polyethylene
couple and cemented implants; In young and active, we select
alumina on alumina combination which resumed in
cementless acetabular fixation, and cementless or cemented
stem depending on stem retrieval method.
Stem retrieval of a well fixed cementless stem is performed
via a large transtrochanteric approach associated with a transfemoral
one. Repair is performed using cerclage and long
cemented stem with or without HA/TCP granules impacted.
Cement retrieval is at the moment performed since 4 years
using Ultra sound (Oscar*) material, which in our hand is very
successful specially for retractor retrieval. This allows easy
retrieval without fenestration. Then medullary canal is reamed
in order to receive either a cemented or sometimes a cementless
stem, depending on the bone quality.
Frequently we used a modified Link technique replacing
allogenic morcellised bone by hydroxyapatite granules (45
cases). This can be done either with a cemented or a cementless
stem.
In case of very severe bone loss and osteolysis, we performed
massive allogenic bone transplant associated with long cemented
stem and distal HA granules with cement. (18 cases).
As we usually performed one stage revision for septic cases,
strategy is not different; It is only in selected cases with many
sepsis recurrences and specially aggressive bacteria that
we performed a two stage procedure.
Our goal is always to get a step down to keep the maximum
living bone; and also to get the best functional outcome permitted.
RESULTS WITH CEMENTLESS STEM
REVISION
Karl Zweymüller
Orthopädische Krankenhaus Gersthof,
Wien (Austria)
THE MANAGEMENT OF PERIPROSTHETIC
FEMORAL FRACTURES UTILIZING
A CEMENTLESS TOTAL HIP REVISION
SYSTEM WITH MODULAR DISTAL
FIXATION
Robert A. Fada, MD; Jose A. Rodriguez, MD; Thomas K.
Tkach, MD; Tyler McKee, DO; Jodi F. Hartman, MS; and
Michelle L. Wright, BS
Lenox Hill Hospital. New York (USA)
Periprosthetic femoral fractures after total hip arthroplasty
are increasing in frequency and pose a significant technical
challenge to the orthopaedic surgeon. The purpose of this
study was to perform a multi-center, retrospective review of
periprosthetic femoral fractures managed with a specific
cementless, corundumized, modular revision femoral component
and report the results at a minimum 1-year follow-up.
Pre op planning is performed to try and predict the implant
length and depth of penetration. When possible, a 5 cm extent
of bone contact is sought within the distal fragment. The
surgical technique involves removal of the implant in place,
using the fracture site to gain access to any remaining points
of fixation. When necessary for proximal spot welds, the
proximal fragment can be split longitudinally as in a Wagner
technique to allow access to the fixation points. The fracture
is exposed only to the extent necessary to allow implant extraction
and obtain reduction. Every attempt is made to protect
the quadriceps fibers attachment, particularly to the distal
fragment. The distal fragment is reamed through the fracture
site to assure proper positioning, and checking the reamer
position using an image intensifier. Once distal fragment
position and contact is assured, the proximal fragment is
reamed to allow clear implant passage. The distal stem is
then inserted to the predetermined position while maintaining