Revision stem:procedure

Dear Surgeons,

we will present a surgical case of revision stem (Promotion) for the treatment of:

•  aseptic loosening of hip stem
•  treatment of periprosthetic femur fractures Type Vancouver B2 (or B3)

Preoperative: case of Versys ET prosthesis with Trilogy hip and PE Inlay (from year 2004). Trauma, Vanvouver B2 (intra OP), so we decided for revision stem.

Procedure: lateral position (rigth side), lateral incision over trochanter major, from 6 cm proximal of greater trochanter distal to the fracture..

Uncemented stem was loose (Vancouver B2).  Main trochanter fragment was dislocated to anterior (leaving attached the muscles).  Capsule opening lateral of stem-neck

Removal prosthesis

(no debris of PE, PE was completely intact: after 13 years !!!)

Cerclage of distal fragment - here: wire 1.5 (to protect) and measuring distance to trochanter-tip

• Revision stem rasp until size 16 (here in this case)  - you should always try to achieve correct leg length  with "the smallest size of body and neck to reach the greater trochanter" : you decide this on the tagged rasp holder (see the image above)

This gives you enough space when the definitive stem is moving more distally than the rasp (this happens always, because you mustn't push the rasp distally as much as possibile, otherwise you would have difficulty to remove it).

• Definitive long curved stem (the movement of the definitive stem was much more than the trial stem, so we need interposition of 3 cm )
• trial reduction with trial body and trial head (definitive stem, trial body connected to the definitive stem - don't use screw, you need this passage only for leg length) . Here: lenghtening with intermediate spacer of 3 cm
• definitive reduction with short body and long 36mm head
• Reduction of trochanter fragment and cerclage with supercable
• Hip stable
• Wound closure

Link: short description of revision stem technique Promotion