Revision total hip arthroplasty

With the steep rise in the prevalence of total hip arthroplasty (THA), revision THA has become a common procedure and presents numerous challenges to the surgeon. The purpose of this article was to review some of the more demanding aspects of total hip revision surgery, focusing on a number of the recently introduced reconstructive concepts. Surgical exposure should be carefully selected to allow proper access for removal of old components and reconstruction while minimizing bone and soft tissue damage. While the posterolateral approach may be sufficient for many cases, more extensile approaches, such as the trochanteric sliding osteotomy, may improve exposure for more demanding reconstruction. Additionally, the extended trochanteric osteotomy facilitates extraction of femoral stems. While minimal femoral bone loss may be treated by conventional primary stems, more severe bone loss will adequately be managed by modular distal fixation stems. Contained acetabular defects may be managed with cementless highly porous cups when primary stability can be achieved. When no primary stability may be attained, the cup-cage construct is a reliable, though demanding, reconstruction technique. Non contained defects require structural support in the form of allograft or metal augments. Two stage revision surgery with the use of antibiotic impregnated cement spacers is currently the standard of care for chronic infected THA. In the multiply revised hip, the rates of major complications, such as infection and dislocation, increases dramatically after the 4(th) revision.