Use of Limited Femorotomy as an Alternative to Extensive Trochanteric Osteotomy for Cementless Femoral Prosthesis Revision

IF 2.1 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2025-04-01 Epub Date: 2025-02-25 DOI:10.1016/j.artd.2025.101640

Thomas Aubert MD, Aurelien Hallé MD, Florian Kruse MD, Simon Marmor MD, Luc Lhotellier MD, Wilfrid Graff MD

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Abstract

Background

Cementless stem extraction during hip arthroplasty revision can be challenging and sometimes requires a femoral opening to be performed with limited posterior femorotomy techniques been described. The study objective was to assess the efficacy of these techniques and the perioperative and postoperative complication rates.

Methods

This study included 224 patients who underwent cementless stem revision. Stem extraction followed the same sequence: an initial endomedullary extraction attempt, followed by suspended posterior unicortical vertical diaphyseal femoral osteotomy. Metaphyseal extension of the osteotomy and lateral-distal cortical extension at the stem tip were performed if the procedure failed, followed by extended trochanteric osteotomy (ETO). The incidence rates of perioperative fracture, reimplanted stem type (standard or revision), postoperative subsidence, and fracture were analyzed.

Results

Femoral opening was required in 15.6% of patients; 75% underwent limited femorotomy (28 patients, 75% suspended, and 25% extended), and 25% (7 patients) underwent ETO. Endomedullary extraction was performed in 84.4% (189) of the patients. The perioperative fracture rates were 16.9%, 0%, and 14.3% in the endomedullary, limited femorotomy, and ETO groups, respectively (P = .032). The standard stem utilization rates were 94.9%, 82.1%, 58.6%, and 28.6% (P < .001) for the endomedullary, limited femorotomy, perioperative fracture, and ETO groups, respectively. Postoperatively, the subsidence rates were 7.5%, 0%, and 28.6% (P = .042), and the fracture rates were 4.3%, 3.6%, and 0% (P > .999) in the endomedullary, limited osteotomy, and ETO groups, respectively.

Conclusions

Limited femorotomy techniques are reliable methods for extracting cementless stems, when necessary, with a reduced risk of fracture. Postoperatively, these patients appear to have comparable stem subsidence and a low risk of fracture.

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有限股骨切开术替代广泛股骨粗隆截骨在无骨水泥股骨假体翻修中的应用

背景：在髋关节置换术翻修期间进行无骨水泥柄提取具有挑战性，有时需要在有限的股骨后路切开技术下进行股骨开口。研究的目的是评估这些技术的有效性和围手术期和术后并发症的发生率。方法本研究纳入224例行无骨水泥椎体翻修术的患者。茎拔出遵循相同的顺序：首先尝试髓内髓拔出，然后进行悬挂式后单皮质垂直骨干股截骨。如果手术失败，则进行干骺端截骨延伸和茎尖外侧-远端皮质延伸，然后进行延长粗隆截骨（ETO）。分析围手术期骨折、再植柄类型（标准或改良）、术后下沉和骨折的发生率。结果15.6%的患者需要行股骨开孔术；75%的患者行有限股切开术（28例，75%暂停，25%延长），25%（7例）行ETO。84.4%（189例）的患者行髓内拔出术。髓内组、限股组和ETO组围手术期骨折率分别为16.9%、0%和14.3% （P = 0.032）。标准茎的利用率分别为94.9%、82.1%、58.6%和28.6% (P <；.001)分别适用于髓内膜组、有限股切开术组、围手术期骨折组和ETO组。术后下陷率分别为7.5%、0%和28.6% (P = 0.042)，骨折率分别为4.3%、3.6%和0% (P >；髓内组、有限截骨组和ETO组分别为0.999)。结论有限股切开术是一种可靠的方法，可以在必要时取出无骨水泥骨柄，降低骨折风险。术后，这些患者似乎有类似的茎下沉和骨折的低风险。

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来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.