[Extended Bauer Approach and Transfemoral Approach in THA Revision.].
The number of revision surgeries of the hip joint keeps growing and it brings new problems, especially in cases where the skeleton in the region of the loosened stem is destructed. As we have been pursuing total hip arthroplasty in the Czech Republic for 30 years we know that the life of the implants is reduced, the number of aseptic loosening is increasing. This loosening is associated with the loss of the bone stock, mainly the cortex gets thinner. The revision cemented stem cannot be exactly fixed in the destructed proximal femur and, in addition, the bone is further damaged. Wagner introduces a new concept of the treatment of these severe complications: transfemoral approach, cementless implant - a stem which may be fixed distal to the destruction of the proximal femur. This method provides prerequisites for the formation of the new bone - bone regeneration and the regeneration of the destructed femoral bone stock. The author presents an extended Bauer approach he has been using in revision surgeries since 1983 (in cases where the bone stock has been preserved and the broken stem of the implant or the persisting remnants of the bone cement have to be removed). This technique is used also in the transfemoral approach which differs from the Wagner approach by performing transfemoral osteotomy in the coronal rather than sagittal plane. It allows operating on the patient in the supine position - similarly as during primary implantation. It provides the possibility of a reliable replacement and alignment of the loosened cup and the revision of the medullary canal from the transfemoral approach in the coronal plane, removal of the bone cement, polyethylene granuloma and an exact application of the Wagner stem. It means that the stem must be fixed below the osteotomy level, extending over 10 cm, but minimally 7 cm proximally to the isthmus of the medullary canal. This extended transfemoral approach requires the Wagner stems in the length of 265 mm and 305 mm. With the use of the Wagner stems of the length of 190 mm or 225 mm this approach is usually not indicated. Key words: revision surgery, transfemoral approach, Wagner stem.
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Ortopedicko-traumatoiogická klinika 3. LF UK a FNKV, Praha.