Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty

Abstract

An osteotomy technique for removal of distally fixed cemented and cementless femoral components is described. The anterolateral proximal femur is cut for one third of its circumference, extended distally, and levered open on an anterolateral hinge of periosteum and muscle. This creates an intact muscle-osseous sleeve composed of the gluteus medius, greater trochanter, anterolateral femoral diaphysis, and vastus lateralis, and exposes the fixation surface as well as distal cement. This technique combines the advantages of an extremely wide exposure of component fixation surfaces and preservation of soft tissue attachments to cut bone. In addition, it allows alteration of the proximal femur to facilitate accurate and safe distal cement removal and canal machining under direct vision. The possibility of placing the component in varus is eliminated. The proximal femur is allowed to conform more accurately to the revision prosthesis, a weakened or damaged trochanter is protected from iatrogenic injury, and soft tissue tension can be adjusted. The osteotomy is then repaired with cerclage wires or cables. The first 20 patients treated with this technique are reviewed. Excellent cement and component removal and optimal revision component implantation were obtained with no change in postoperative regimen and reliable healing.