Posterior longitudinal strip osteotomy of proximal femur in revision total hip arthroplasty / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the treatment and effect of a technique using single femoral posterior longitudinal strip osteotomy in revision total hip arthroplasties.</p><p><b>METHODS</b>Between September 2005 and December 2009, 35 hips of 35 patients underwent a revision total hip arthroplasties (THA) in conjunction with extraction of femoral components. Among them, 23 cases were with uncemented, and 12 cases were with cemented femoral components. Those cases being followed up were chosen by two standards described as follows one was the examination of preoperative radiographs, which showed that there was difficult in the extraction of the femoral components; Another followed was the trying with routine procedure to remove the stem. If these were unsuccessful, a single longitudinal strip osteotomy was performed, whose length was about 11 - 14 cm, and width was about 1 cm. Then the femoral component was disimpact. The osteotomy was fixed with wires or cables. If there was cortical deficiency or insufficient cancellous bone, grafting was performed. A cementless composite revision prosthesis of the Lima-Lto with a tapered modular distal fixation stem was used. All the patients were evaluated with preoperative and postoperative Harris score, the length of limb and radiographs.</p><p><b>RESULTS</b>All cases were followed up with 5 to 55 months, average 15 months. Compared with preoperative, the average Harris score increased from 30 (range, 19 - 40 points) to 85 points (range, 80 - 92 points). All pains of hip joint were alleviated from the mean 12 points (range, 10 - 20 points) before the operation to 40 points (range, 30 - 44 points) after the operation. All the femoral osteotomy and bone grafting were healing ultimately. And on average, the healing began in 20 weeks (range, 10 - 32 weeks). All the cases remain the same length of lower limbs. There was no hip joint dislocation, loosening or infection.</p><p><b>CONCLUSIONS</b>The femoral posterior longitudinal strip osteotomy facilitates the exposure and extraction of the femoral stem, the clear up of medullary cavity and then the femoral reconstruction in revision total hip arthroplasties. It has satisfactory short-term radiographic evaluation and clinical effect as a simple, effective and reliable technique.</p>