The Principles of Femoral Reconstruction

    In revision total hip arthroplasty (THA), a key objective is obtaining secure fixation. In doing so, the orthopaedic surgeon must also create a stable joint, maximize joint biomechanics, and restore bone stock.

    At the Philadelphia Revision Course, Nitin Goyal, MD, from the Anderson Orthopaedic Clinic in Alexandria, Virginia, discussed the principles of femoral reconstruction in a revision THA.

    Obtain secure fixation. Axial and rotational stability are important. It is easy to achieve stability if the patient has good bone quality, but problematic if the bone is damaged. Distal fixation has been shown to be an excellent option, Dr. Goyal said.

    Create a stable joint. This is critical – patients with severe bone damage tend to have severe soft tissue damage as well, making stability a problem. Component positioning must be optimized, Dr. Goyal said, to get the cup in the right place. This directly impacts component stability. The orthopaedic surgeon can use a large head, which creates less chance for impingement and allows for a higher jump distance, both important to a stable joint.

    Maximize joint biomechanics. Joint biomechanics are directly related to the orthopaedic surgeon’s ability to create stability. Restoring leg length and offset are crucial.

    Restore bone stock. Dr. Goyal recommends using an extended trochanteric osteotomy to help minimize bone loss during stem and cement removal. Bone grafts are rarely needed; a well-fixed stem should allow for bone recovery. The exceptions are to provide calcar support or prosthesis protection.

    Dr. Goyal’s presentation can be found here.