Abstract
From 1992 to 1996, 142 consecutive hip revisions were performed with the use of an extended proximal femoral osteotomy. Twenty patients had insufficient follow-up or were followed elsewhere and were excluded from the review. The remaining 122 revisions included 83 women and 39 men. Average age at time of revision was 63.8 (26–84) years. Indications for revision were aseptic loosening (114), component failure (4), recurrent dislocation (2), femoral fracture (1), and second stage re-implantation for infection (1).
The extended proximal femoral osteotomy gave easy access to the distal bone-cement or bone-prosthesis interface in all cases. It allowed neutral reaming of the femoral canal and implantation of the revision component in proper alignment. Varus remodelling of the proximal femur secondary to loosening was handled with relative ease implementing the osteotomy. Average time from the beginning of the osteotomy procedure to the complete removal of prosthesis and cement was thirty-five minutes. There were no non-unions of the osteotomised fragments at an average post-op follow- up of 2.6 years with no cases of proximal migration of the greater trochanteric fragment greater than 2 mm. There was evidence of radiographic union of the osteotomy site in all cases by 3 months. Stem fixation with bone ingrowth was noted in 112 (92%) of 122 hips, stable fibrous fixation was seen in nine (7%) and one stem (1%) was unstable and was subsequently revised.
We have found that use of the osteotomy is an efficient, safe, and reliable technique in revision hip arthroplasty. The advantages include easier access to the fixation surface of the failed prosthesis without compromising the remaining bone stock, alteration of proximal bone deformities to allow neutral reaming of the femoral canal, predictable healing of the osteotomised fragment, proper tensioning of the abductors with distal advancement, decreased operative time, and enhanced exposure of the acetabulum.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
