femoral component revision with use of impaction bone- grafting and a cemented polished stem by b....

Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem

by B. Willem Schreurs, J.J. Chris Arts, Nico Verdonschot, Pieter Buma, Tom J.J.H. Slooff, and Jean W.M. Gardeniers

JBJS Essent Surg TechVolume os-88(1 suppl 2):259-274

September 1, 2006

©2006 by The Journal of Bone and Joint Surgery, Inc.

Careful preplanning with use of special templates is essential to be aware of areas with cortical weakness and areas that need to be reconstructed with mesh, strut graft, or a plate; to plan the

position of the plug; and to select the size of the proximal i...

B. Willem Schreurs et al. J Bone Joint Surg Am 2006;os-88:259-274


Cortical wall defects should be exposed and repaired with use of metal mesh on the outside of the femur.



Femoral head reamer set used to facilitate the removal of cartilage from the femoral head.



The intramedullary plug, which is mounted on the central wire, is inserted at the preplanned position.



The next step is to establish how far each size of distal impactor can be inserted into the femoral canal before it jams against the femoral cortical walls.



After the correct size of the proximal impactor has been chosen, attention is focused on segmental osseous defects in the calcar region.



Reconstruction of the calcar area with a metal mesh and cerclage wires.



The reconstruction with bone graft is started.



The canal is filled with solid impacted graft until the distal impaction line is reached.



Next, the most proximal area is filled layer by layer and impacted with use of the previously selected proximal impactor.



Intraoperative view of the impaction procedure, with a distal impactor (left) or a proximal impactor (right) mounted on the sliding hammer.



Impaction should be very tight, especially in the calcar region, where larger bone chips (6 to 8 mm) can be used.



View of the reconstructed calcar area just after removal of the proximal impactor.



A cement syringe with a small-diameter nozzle is used to inject the cement distally in the graft reconstruction.



A centralizer without wings is used on the tip of the prosthesis to guide it through the reconstruction.



Radiograph made three years after reconstruction with femoral impaction bone-grafting.



For patients with bone stock lysis or deficiency at or beyond the tip of the primary stem, a special set of instruments was developed to bypass the weak area with impacted bone graft in

combination with a long Exeter stem.



Fig. 18-A Preoperative radiograph showing a failed cemented total hip prosthesis.



femoral component revision with use of impaction bone- grafting and a cemented polished stem by b....

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