Endofemoral Approach and Proximal Primary Stability

Abstract

This option may be considered whenever the femur is straight in the frontal plane and when there are no significant bone defects. The two articular approaches (antero-lateral and postero-lateral) can be used. After luxation and removal of the prosthesis perform an exteriorization of the femur. Make a wide opening of the greater trochanter (A trochanteric osteotomy constitutes, at the same time, an articular and a femoral approach). Remove the intermediate and the distal cement plug (a femoral window can be necessary). Calibrate the medullary canal and adjust the opening of the greater trochanter in its lateral and posterior zones with a long reamer.

Preparation of a proximal anchorage zone in two steps with a modular rasp (metaphyseo-diaphyseal and metaphyseal zone). When the stability in the proximal region is precarious, it is completed in the diaphyseal region by using a reamer. Selection and implantation of the definitive stem after assembling of the two prosthetic components with a torque wrench outside the femur if modular stem

Articular closure and if trochanteric osteotomy perform an osteosynthesis with three metal wires and complete it by a metal wire that form a lateral tension band.