Table 1 Technical challenges and strategies
Challenge | Strategy | Reference |
|---|---|---|
Surgical exposure | Trochanteric sliding osteotomy | |
Removal of previous fixation devices | Dislocating the hip joint before removing; excising the femoral head with the lag screw in situ | |
Removal of broken screws | Trephines, grasping tools, a standard broken screw removal set and a metal-cutting high-speed burr | |
Revision internal fixation | Avoiding a varus malreduction and obtaining stable fixation (compression technique and bone grafting) | |
Bone deformity of proximal femur | Restoring the relationship between the tip of greater trochanter and the center of femoral head rotation | [19] |
Femoral canal preparation for revision arthroplasty | Endosteal sclerotic bone removal: gauge osteotome and/or a burr; refereing horizontal axis of the knee joint to adjust the anteversion of the stem; using C-arm image intensifier or fluoroscopic image intensifier to guide the placement of the stem | |
Bone defect of proximal femur | Calcar-replacing and long-stem implant combined with or without a prophylactic cable; tumor-type endoprosthesis | |
Leakage of cement through screw holes | Finger pressure, packed gauze, re-inserted screws, surgical glove inflated with saline, fashioned bone plug | |
Acetabula preparation in patients with poor bone quality | Reaming acetabular cartilage judiciously; avoiding forceful component impaction; considering screws augmentation | |
Greater trochanter reattachment | Contoured plating, tension band wiring and trochanter claw plate with wiring |