Transverse femoral osteotomy for revision surgery — an alternative to the transfemoral approach

Objective  Exchange of a loosened femoral component in the presence of large proximal bone defects which require a distal anchorage of the revision stem. Indications  Removal of remaining cement fragments from distal femur. Extraction of broken part(s) of femoral component. Marked anterior bowing of femoral shaft before insertion of revision stem. Contraindications  Severe osteopenia of the femoral shaft. Infection. Poor general health. Surgical Technique  Removal of femoral component. Transverse femoral osteotomy at least 12 cm distal to the tip of the greater trochanter. Removal of remaining cement from distal and proximal fragments. Conical reaming of distal femur. If necessary, prophylactic wire cerclage of distal fragment. Inserttion of revision stem through the proximal fragment and impaction into the distal fragment. Packing of the defect of the proximal fragment with corticocancellous bone grafts to increase stability. Results  Assessment of twelve patients (eight women, four men, average age at surgery 70 years and 1 month). Average length of follow-up 2 years and 11 months (1 year, 9 months to 5 years, 10 months). Average Harris hip score 80.2 points. Merle d’Aubigné score: four excellent, one good, two satisfactory, four acceptable, and one poor result. A sufficient bony bridging of the osteotomy gap was seen radiologically in all patients.