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

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.

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.

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.

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.