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The Journal of Bone and Joint Surgery 81:1326-36 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Fixation with a Modular Stem in Revision Total Hip Arthroplasty*{dagger}

JAMES V. BONO, M.D.{ddagger}, JOSEPH C. MCCARTHY, M.D.{ddagger}, JO-ANN LEE, R.N.{ddagger}, BOSTON, ROBERT J. CARANGELO, M.D.§, NEW BRITAIN, CONNECTICUT and RODERICK H. TURNER, M.D.{ddagger}, BOSTON, MASSACHUSETTS

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons


   Introduction
 
The goals of femoral revision arthroplasty are to relieve pain, to restore biomechanical function and bone integrity, and to ensure stable fixation of the component. Restoration of biomechanical function involves correction of limb-length discrepancy and femoral offset. Proper positioning and containment of the implant requires thorough preoperative planning as well as precise operative technique.

Loss of femoral bone stock in a patient who needs a revision presents a difficult challenge to the orthopaedic surgeon. Bone loss is a result of mechanical loosening of the component and bone erosion caused by osteolysis. Segmental defects involve loss of supportive cortical bone, whereas cavitary defects involve cancellous-bone loss that may extend to the endosteal cortical bone.

There are several systems for the classification of femoral bone defects, but we prefer the one developed by the American Academy of Orthopaedic Surgeons Committee on the Hip14. According to this system, type I comprises segmental . . . [Full Text of this Article]


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