Surgical Pearls for Femoral Revision

    Dr. Rafael Sierra and Dr. David Markel offer their tips and tricks for removing a well-fixed femoral component, and then reconstructing the femoral side in revision total hip arthroplasty.

    Rafael Sierra, MD, has one key piece of advice for orthopaedic surgeons doing a revision total hip arthroplasty: Don’t try to avoid doing an extended trochanteric osteotomy by attempting to remove the femoral implant from the top. Too many times, he said, he has tried and failed, and then ended up doing the ETO anyway.

    For that reason, the ETO has become his workhorse for removing a well-fixed femoral component. He makes about a 12-cm incision from the tip of the trochanter, but he said the incision can be longer if needed – the situation dictates the incision length.

    At the ICJR’s annual Winter Hip & Knee Course in Vail, Colorado, Dr. Sierra showed three videos that demonstrated the technique for femoral component removal:

    • Removal of a cemented stem
    • Removal of an uncemented stem
    • Removal of a fluted tapered stem, which he says is the hardest to remove

    Dr. Sierra’s presentation can be found here.

    For femoral reconstruction, David Markel, MD, said it’s important to know what component was originally used, why it failed, and how it will be removed. These points help the surgeon determine what equipment is needed for the component removal and what type of implant can be used for the revision.

    Dr. Markel, who also spoke at the Winter Hip & Knee Course, said that matching the disease process with the appropriate implant is key. The Paprosky Femoral Deficiency Classification is a useful tool in this effort, as it provides guidance on the types of stems that can be used given the amount of femoral bone remaining after the failed component is removed.

    Dr. Markel also showed a series of video vignettes demonstrating:

    • Technique for component removal without cutting the femur
    • ETO technique
    • Implantation of the new component

    Dr. Markel’s presentation can be found here.