Anterior windowing of the femur diaphysis for cement removal in revision surgery

Abstract

Meticulous cement removal around loosened cemented hip implants is the key to successful reconstruction. In this study, the outcome of windowing the anterior femoral diaphysis was evaluated. Cementless straight tapered revision stems not filling the medullary canal were implanted without regard to bridging the window distally. The nonvascularized cortical lids were replanted after previous periosteal stripping. Forty-one procedures done between 1991 and 2001 were reviewed after 3.5 to 11.9 (mean, 7.4) years. The implant tip was distal to the distal end of the window in 54% of cases. Except in one case, it did not project beyond the window distally by at least twice the diaphyseal width. The implant tip was proximal to the distal end of the window in 29% and level with it in 17%. None of the patients developed stress fractures. Early postoperative subsidence was observed in four instances, but was irrelevant for implant stability at followup. One patient had revision surgery for low-grade infection. All cortical lids were radiologically re-osseointegrated after 4 to 29 months. Revision stems not bridging the defect distally and cortical lids stripped of periosteum were not associated with any disadvantages. Their use can be recommended using the surgical technique described.

Level of evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.