Femoral windows in revision total hip arthroplasty

In 21 revision total hip arthroplasties (THA), a 2-5-cm window was cut into the anterolateral cortex of the femur, and the cement distal to the window was removed under direct vision. In each case, a cemented THA was revised to a noncemented implant that bypassed the window by at least two femur diameters. The section of cortical bone was replaced; autogeneic bone graft was applied to the osteotomy site, and cerclage wires were used to hold the window in place. Postoperatively, all patients were maintained at partial weight-bearing (touchdown) for six weeks and then advanced as they were able. The mean follow-up time in this series was 22 months. Access to the femoral cement was greatly facilitated by the use of a femoral window. There were no intraoperative femoral fractures or inadvertent femoral perforations during cement removal. The mean healing time for the windows was 17 weeks. There was no association of femoral thigh pain or implant loosening with femoral windows. The windows heal rapidly and have not been associated with perioperative femoral fractures.