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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

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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Acknowledgments

We thank Aude Tavenard for the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Centre hospitalier Bienne, Vogelsang 84, 2500, Bienne, Switzerland

    Daniel F. A. de Menezes MD & Hans-Peter Sieber MD

  2. 11 Galeries du Théâtre, 35000, Rennes, France

    Pierre Le Béguec MD

  3. Department of Orthopaedics, Polyclinique Sévigné, Cesson-Sévigné, France

    Mathias Goldschild MD

Authors
  1. Daniel F. A. de Menezes MD
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  2. Pierre Le Béguec MD
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  3. Hans-Peter Sieber MD
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  4. Mathias Goldschild MD
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Corresponding author

Correspondence to Daniel F. A. de Menezes MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Polyclinique Sévigné.

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de Menezes, D.F.A., Le Béguec, P., Sieber, HP. et al. Stem and Osteotomy Length are Critical for Success of the Transfemoral Approach and Cementless Stem Revision. Clin Orthop Relat Res 470, 883–888 (2012). https://doi.org/10.1007/s11999-011-1998-4

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  • DOI: https://doi.org/10.1007/s11999-011-1998-4

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