By Prof. Bernd Fink, Orthopädische Klinik Markgröningen, Markgröningen, Germany
As a general rule, my tips & tricks for revision arthroplasty are for preoperative planning which, in my opinion, is critical to surgical success. I have three principles for a good start:
- Thorough preoperative planning is compulsory to decide the appropriate surgical approach (standard endo-femoral, transfemoral, ETO, etc.)
- Follow the stem anchorage or fixation zone planning; this will help determine the proper stem variant. In this step, it is important to consider the stem taper. I tend to use 2° tapered stems because, whenever possible, I am seeking a distal cone-in-cone fixation, which has shown excellent results.1 It allows a consistent fixation zone along the femoral isthmus and down to the tip of the stem.
- Try to choose a revision stem that is as short as possible. A short stem should help decrease the risk of periprosthetic fracture by bypassing the isthmus. It gives more options in the case of further revisions and it helps minimize the risk of inter-prosthetic fracture in the case of knee replacement. A short modular stem implies a short distal component combined with a long proximal component. Therefore, the junction zone is placed in the area of the supporting bone, which helps decrease the risk of junction fracture in modular hip revision.2-4
In short: Plan the approach, plan the fixation zone in the isthmus, and select a revision stem as short as possible; then you are ready to go!