Strategies for stem revision : Surgery planning, implant removal and reimplantation

Abstract

Femoral revision represents achallenging procedure in its surgical planning and technical execution. The results are mainly dependent on the bone loss present, the quality of the implant removal and the choice of revision system. Patient-specific factors such as age, comorbidities, bone quality or even the localization of the cement have adecisive influence on the surgical strategy. Appropriate preoperative preparation, including the presence of the necessary special instruments, which are essential for gentle implant removal, is indispensable to achieve the best possible result. Abone-sparing implant removal can be particularly challenging, especially in the case of well-fixed stems and cement residues, which may extend far beyond the isthmus. In such situations, atransfemoral approach should be considered. Cementless reimplantation using modular or non-modular titanium stems is currently the preferred treatment of choice for most revisions. In elderly, low-demand patients or with poor bone quality, cemented revision remains agood alternative treatment option.