[Extended approach in hip revision and preservation of the muscles. Is that possible?]

For revision of hip prostheses several standard and extended approaches can be used. The goal of these approaches is a good visualisation with minimal trauma of the bone and its vascularisation as well as of the muscles. Of the extended approaches we prefer the transfemoral approach in a modified technique. This approach is indicated when the stem of the endoprosthesis is broken, when the femoral axis has shifted because of stem loosening, or when the bone has become noticeably thin, which by itself or in combination would greatly increase the risk of an intraoperative fracture or perforation. Similarly, it is indicated in cases in which the cement mantle was stable, when a periprosthetic fracture of Vancouver B2 or B3 type is present or when a loose cementless stem with a coarsely porous surface cannot be removed in an endofemoral manner. In a published study of 68 patients with hip revisions using this modified transfemoral approach, we could see a continuous increase of the Harris hip score from 41.4 points preoperatively to 85.9 points 24 months postoperatively. Healing of the bony flap was seen in 98.5 % of the cases. Two postoperative non-dislocated trochanter fractures could be treated conservatively. The transfemoral approach is an extended approach with sparing of the gluteal muscles and the vasto-gluteal sling. Reproducible good clinical results can be achieved.