title: A modified transfemoral approach using modular cementless revision stems.
abstract: The transfemoral approach in its traditional form, using a nonmodular Wagner self-locking revision stem, has the disadvantages of a less predictable union rate of the bony flap and a high rate of stem subsidence. To investigate whether this situation can be improved by using a modified transfemoral approach and modular curved cementless revision stems, we prospectively analyzed 68 hip revisions and followed them clinically and radiographically for a minimum of 24 months (mean +/- standard deviation, 32.4 +/- 11.2 months). One year after the operation, the osteotomy showed bony consolidation in all but one case (98.5%). We noted subsidence in six cases (8.8%) and two of these stems became loose. In all of these cases, the circular fixation zone of the stem in the isthmus of the femur was less than 3 cm. The Harris hip score improved continuously from 41.4 +/- 14.5 points preoperatively to 85.9 +/- 14.6 points 24 months postoperatively. The modified transfemoral approach in combination with a curved, modular revision stem showed reproducibly good results concerning union of the bony flap and subsidence of the stem if the fixation zone was not less than 3 cm.
authors.affiliation: Department of Joint Replacement, General and Rheumatic Ortho paedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany. b.fink@okm.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Fink
authors.forename: Alexandra
authors.initials: A
authors.lastname: Grossmann
authors.forename: Svenja
authors.initials: S
authors.lastname: Schubring
authors.forename: Martin S
authors.initials: MS
authors.lastname: Schulz
authors.forename: Martin
authors.initials: M
authors.lastname: Fuerst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods; D001843:Bone Cements; D005260:Female; D005270:Femur Head / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements