MASSIVE GREATER TROCHANTOTOMY FOR REVISION RECONSTRUCTION OF THE LOWER FEMUR

Abstract

Purpose: During revision procedures for total knee arthroplasty with reconstruction of the lower femur (TKA after tumour resection) it is difficult to extract the stem from the proximal femur (if noncemented) and spare bone stock. The purpose of this study was to describe and analyse aspects related to the use of a complementary approach for massive trochanterotomy allowing easier access to the centromedullary canal of the femur and thus facilitate extraction of the femoral stem and periprosthetic cement.

Material and methods: This technique was used for five patients between 1991 and 1999. There were four women and one man, aged 18–45 years. The femoral piece was changed in three patients because of a fractured non-loosened implant and in two cases because of loosening. The revision implant was a total reconstruction prosthesis in one case (Link) and a GUEPAR implant in four. Massive trochanterotomy or corticotrochanterotomy was performed in all cases sparing the muscle insertions.

Results: This retrospective analysis was performed at a mean follow-up of five years (3–12). There were no cases of loosening or implant fracture. The trochanteric fragment (or corticotrochanteric fragment) healed normally in all cases. One female patient experienced moderate pain in the sitting position related to the presence of osteosynthesis material in the hip, but no implant removal was necessary.

Conclusion: Complementary trochantotomy facilitated removal of the inferior femoral piece via a direct approach to the summit of the stem allowing direct expulsion with the periprosthetic cement. Direct vertical access to the medullary canal allows good control of the revision prosthesis and limits unnecessary bone loss without creating any particular iatrogenic problem other than longer time for trochanter healing.