Key Points The success of revision surgery of the hip can be divided into 3 parts: the prosthesis design, the surgical technique, and the patient. Surgical technique is probably the most important factor. The surgeon should understand the concept of…
Key Points Planning: Careful preoperative templating Instruments: Specific and complete instrumentation Implants: System of fully hydroxyapatite-coated stems Fixation: As proximal as possible Anchoring: As distal as necessary Introduction The choice of cementless versus cemented implants for mild and moderate bone…
Key Points Managing femoral bone loss in revision total hip arthroplasty is challenging, requiring meticulous clinical evaluation and preoperative planning. The ideal revision femoral stem is easy to insert, can be used to treat most revision situations, and has reproducible…
Key Points Impaction bone grafting provides restoration of bone stock loss. It is indicated for any age, but particularly in younger patients. The surgeon must adequately bypass and protect lytic defects or areas of weakness within the proximal femur with…
Key Points Cement-bone interface strength is reduced in revisions owing to loss of cancellous bone and less cement interdigitation with bone. The historical rate of cemented femoral component failure was high when cemented revisions were used in all cases owing…
Key Points Failure of a primary total hip arthroplasty (THA) typically occurs with varying degrees of femoral bone loss. Classifying femoral bone defects is a critical part of the preoperative planning required for a successful revision THA. Paprosky, the American…
Key Points Several key steps are required to maximize the chance of a successful reconstruction and durable long-term fixation: Obtain excellent acetabular exposure and visualization. Minimize bone damage during prior implant removal. Cancellous bone grafting of contained bone defects. Maximize…
Key Points A thorough preoperative radiographic examination, including thin-slice computed tomography, is necessary to evaluate osseous defects and help identify a pelvic discontinuity. Extensive planning is necessary in the design of custom triflanged acetabular components (CTACs), which is a dynamic…
Key Points Acetabular impaction grafting allows restoration of bone stock and normal hip biomechanics. Acetabular impaction grafting is particularly successful as a technique for the reconstruction of cavitary defects. It is a technically exacting procedure; attention to surgical detail is…
Key Points A cementless hemispheric acetabular component has become the preferred system to employ for most acetabular revisions. Radiographic evidence of polyethylene wear with significant osteolysis warrants acetabular revision even in the absence of clinical or functional symptoms. The most…