Femoral bone remodeling in hip revision surgery

The femoral revision stem bridges an extensive bone defect with an implant anchored in the diaphysis to restore the function of the limb. The transfemoral approach opens the medullary canal by creating a posterolateral bony lid that remains attached to the surrounding soft tissues. Then, the loosened component, the bone cement, and the granulation tissue are removed. After reaming of the intact femoral canal distal to the site of osteolysis, the noncemented revision prosthesis is inserted. Between 1969 and 1992, 69 revision procedures were performed using the transfemoral approach. The average follow-up period was 6.5 years (range, 5-9 years). All patients had an extensive loosening (Paprosky stage 2c and 3). In 4 patients, an infected component was exchanged. The transfemoral approach allows a radical debridement of infected implants. The Merle d'Aubigne score improved from a preoperative value of 6.9 points to 13.7 points at time of follow-up. At the time of the last follow-up, all patients were pain free. Without using bone grafts, bone remodeling of the osteolytic zones was observed in all patients. Careful attention to details is the key to the prevention of serious complications.