Summary
Objectives
Bridging of an extensive bone defect with a long stem revision prosthesis anchored in the diaphysis to restore a pain free function of the limb.
Indications
Femoral component loosening with extensive osteolysis, stem fractures and periprosthetic fractures.
Contraindications
Minimally damaged stable cortex.
Extensive osteolyses precluding a stable diaphyseal anchorage of the prosthetic stem.
Surgical Technique
Opening of the medullary canal by creating a posterolateral bony lid which remains attached to the surrounding soft tissues (transfemoral approach). Removal of the loosened component, the bone cement and the granulation tissue. After reaming of the intact femoral canal distal to the site of osteolysis insertion of a non cemented, well fitting revision prosthesis having a stem with 8 conically shaped ribs.
Results
Between 1969 and 1992 we performed 69 revision procedures using the transfemoral approach. The average follow-up period was 6.5 years (5 to 9 years). Twenty-nine patients could not be followed up (11 died, 8 lived in nursing homes, 9 could not be reached). All patients had an extensive loosening (Paprosky Stage 2c and 3). Twenty-six complications occurred in 16 patients: 2 dislocations, 4 delayed consolidations, 3 ectopic ossifications, 2 transient peroneal nerve pareses, 7 hematomas, 1 lung embolism, 7 implant subsidences. Careful attention to details is the prevention of serious complications. The transfemoral approach allows a radical debridement of infected implants. The Merle d’Aubigné score improved from preoperative 6.9 to 13.7 points at follow-up. At the last follow-up all patients were pain free.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brooker A, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. J Bone Joint Surg [Am] 1973;55:1629–32.
Charnley J. Numerical grading of clinical results. In: Charnley J. Low friction arthroplasty of the hip. Theory and practice. New York, Springer, 1979:23–4.
Hartwig C-H, Böhm P, Czech U, et al. The Wagner revision stem in alloarthroplasty of the hip. Arch Orthop Trauma Surg 1996;115:5–9.
Kolstad K, Adalbeth G, Mallmin H, et al. The Wagner revision stem for severe osteolysis. Acta Orthop Scand 1996;67:541–4.
Müller ME, Jaberg H. Total hip reconstruction. In: McCollister EC, ed. Surgery of the musculoskeletal system, 2nd edn. New York: Churchill Livingstone, 1982:2979–3017.
Paprosky WG. Femoral defect classification: clinical application. Orthop Rev 1990;14:Suppl:9–15.
Schenk RK, Wehrli U. Zur Reaktion des Knochens auf eine zementfreie SL-Femur-Revisionsprothese. Histologische Befunde an einem fünfeinhalb Monate postoperationem gewonnenen Autopsiepräparat. Orthopäde 1989;18:454–62.
Wagner H. Revisionsprothese für das Hüftgelenk. Orthopäde 1989;18:438–53.
Wagner H, Wagner M. Prothesenwechsel mit der Femur-Revisionsprothese. Med Orthop Technik 1997; 117:138–48.
Wagner M, Knorr-Held F, Hohmann D. Measuring stability of wire cerclage in femoral fractures when performing total hip replacement. In vitro study on a standardized bone-model. Arch Orthop Trauma Surg 1996;114:32–7.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wagner, M., Wagner, H. The transfemoral approach for revision of total hip replacement. Orthop Traumatol 7, 260–276 (1999). https://doi.org/10.1007/BF03180945
Issue Date:
DOI: https://doi.org/10.1007/BF03180945