My Tips & Tricks for Revision Hip Arthroplasty

A quick look at tips around preoperative planning for hip revision surgery

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:

  1. Thorough preoperative planning is compulsory to decide the appropriate surgical approach (standard endo-femoral, transfemoral, ETO, etc.)
  2. 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.
  3. 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!

  1. Fink, B. et al. The Bone & Joint Journal. 96-B:889–95. 2014.
  2. Fink, B. et al. Journal of Orthopaedic Trauma. 26 (4). 206–11. 2012.
  3. Fink, B. et al. Journal Clinical Orthopaedics & Related Research. 462. 105-14. 2007.
  4. Fink, B. et al. Archives of Orthopaedic and Trauma Surgery. 129 (1). 65-73. 2009.
This material is intended for healthcare professionals. Distribution to any other recipient is prohibited.
The surgeon presenter is a paid consultant of Zimmer Biomet. The information being presented is of a general nature and does not represent or constitutes medical advice or recommendations and is for medical education purposes only. The information includes descriptions of conditions that a surgeon may encounter and treatment options that may be considered for those conditions.
Because this information does not purport to constitute any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and advised individually, and this information does not replace the need for such examination and/or advice in whole or in part. Zimmer Biomet does not practice medicine.
Each physician should exercise his or her own independent judgment in the diagnosis and treatment of an individual patient, and this information does not purport to replace the comprehensive training physicians have received.
For indications, contraindications, warnings, precautions, potential adverse effects, and patient counseling information, see the package insert or contact your local representative; visit www.zimmerbiomet.com for additional product information.
All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet.
Check for local product clearances and reference product specific instructions for use.
© 2019 Zimmer Biomet