Abstract
Removal of a long cement mantle that is well fixed distally during total hip revision can be a technically demanding procedure with many potential complications.
The extended femoral slot offers a technique that allows direct visualisation during cement removal while maintaining an intact femoral tube.
The proximal end of the femur is exposed taking care to remove all soft tissue that might prevent removal of the loose femoral component. The loose femoral component is removed using thin osteotomes and a femoral extraction device as needed. The proximal cement mantle is removed under direct vision to the level of the flare of the greater trochanter. The outside of the femoral shaft below the flare of the greater trochanter is exposed by splitting the vastus lateralis. Pre-operative measurements are imperative to determine the distal level of the cement mantle. An extended rectangular slot approximately 1.5cm wide is made in the anterolateral aspect of the femur starting just below the flare of the greater trochanter and continuing to the level of the distal aspect of the cement mantle. This can be done using a pencil-tipped burr on the Midas Rex or an oscillating saw. The rectangular strip of bone is removed and saved to be replaced and secured with cerclage technique during closure.
The entire cement mantle is removed under direct vision using osteotomes and other cement removing instruments as needed. The opened femoral canal is then reamed to accept a new revision femoral component.
The extended femoral slot is a safe and effective technique for cement removal during revision hip arthroplasty in selected cases. It is not used when there is varus deformity of the proximal femur but in selected cases is an alternative to the extended greater trochanteric osteotomy and preserves the circumference of the femoral tube.
