EXTENDED PROXIMAL FEMORAL OSTEOTOMY - A NEW TECHNIQUE FOR FEMORAL REVISION ARTHROPLASTY

An osteotomy technique for removal of distally fixed cemented and ceme ntless femoral components is described. The anterolateral proximal fem ur is cut or one third of its circumference, extended distally, and le vered open on an anterolateral hinge of periosteum and muscle. This cr eates an intact muscle-osseous sleeve composed of the gluteus medius, greater trochanter, anterolateral femoral diaphysis, and vastus latera lis, and exposes the fixation surface as well as distal cement. This t echnique combines the advantages of an extremely wide exposure of comp onent 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 varu s is eliminated. The proximal femur is allowed to conform more accurat ely to the revision prosthesis, a weakened or damaged trochanter is pr otected from iatrogenic injury, and soft tissue tension can be adjuste d. The osteotomy is then repaired with cerclage wires or cables. The f irst 20 patients treated with this technique are reviewed. Excellent c ement and component removal and optimal revision component implantatio n were obtained with no change in postoperative regimen and reliable h ealing.