title: The Transfemoral Approach for Removal of Well-Fixed Femoral Stems in 2-Stage Septic Hip Revision.
abstract: The value of a transfemoral approach for removal of well-fixed infected hip arthroplasties in 2-stage revision is unclear, especially whether cerclages for closure of the flap in the first step lead to higher reinfection rates and whether reopening of the flap for reimplantation of a hip arthroplasty leads to a lower union rate of the bony flap.
  
  
  
  Seventy-six septic 2-stage revisions via a transfemoral approach with cerclages for closure of the flap in the first step and reopening of the flap for reimplantation were followed prospectively for a mean period of 51.2 ± 23.2 (24-118) months.
  
  
  
  The union rate of the bony flap after reimplantation was 98.7%, and no recurrence of reinfection was recorded in 93.4% of all cases. Subsidence of the stem occurred at a rate of 6.6%, dislocation at a rate of 6.6%, and there was no aseptic loosening of the implants. The Harris Hip Score was 62.2 ± 12.6 points with the spacer and 86.6 ± 15.5 points 2 years after reimplantation. Nine fractures (11.8%) of the flap occurred during the operation because of osteolytic or osteoporotic weakness of the flap itself, but these all healed without further intervention.
  
  
  
  The transfemoral approach is a safe method for septic revision of well-fixed hip prostheses, and the use of cerclage wires for closing the osteotomy flap in the first stage does not appear to lead to a higher reinfection rate. Similarly, the reopening of the flap does not appear to decrease the union rate of the flap.
authors.affiliation: Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany; Orthopaedic Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Fink
authors.affiliation: Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany.
authors.forename: Damian
authors.initials: D
authors.lastname: Oremek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013524:Surgical Flaps
keywords: extended trochanteric osteotomy; hip revision arthroplasty; septic two-stage revision; stem removal; transfemoral approach