304. OUTCOME OF FEMOROTOMY FOR REVISION TOTAL HIP ARTHROPLASTY

Abstract

Purpose of the study: We have had a growing number of revision total hip arthroplasty (rTHA) which have required femorotomy, either planned preoperatively, or required because of difficult extraction of the cemented implant. Few results have been reported in the literature. The purpose of this work was to evaluate late healing of femoral bone and complications.

Material and methods: For this retrospective analysis, we included 43 patients, mean age 66 years. These patients had a femorotomy during rTHA performed from 1997 to 2008. There were 37 revisions in an aseptic context for isolated femoral loosening (n=26), bipolar loosening (n=4), acetabular loosening (n=4), recurrent dislocation, fracture of the femoral stem, and periprosthetic fracture (n=1 each); there were six revisions in septic conditions. Techniques were: femorotomy (n=22), wide trochanterotomy measuring proximally to distally 12 cm, four cortical cuts and one oblique osteotomy to correct valgus. The reconstruction used locked femoral stems (n=17), cemented stems (n=17) and non-cemented stems (n=10). The osteotomies were closed with cerclage or steel wires.

Results: Bone healing was assessed on the plain x-rays of the hip joint at three, six and twelve months. Among the 43 patients included in this analysis, complete data were available for 37. There were 36 cases of successful healing and one case of nonunion on a wide trochanterotomy. The function outcome was assessed a mean three years.

Discussion: Femorotomy remains a difficult technique, sometimes facilitating stem extraction, but with a high risk of morbidity. The morbidity is difficult to evaluate initially, linked more with time to weight-bearing at two months on average. In this small series we nevertheless found few problems with bone healing, even in septic conditions.

Conclusion: Femorotomy remains a valid option when required. It is a difficult technique but provides reliable results in terms of complete healing three months postoperatively.