'Rail road' proximal femoral osteotomy: a new technique to remove well-fixed femoral stem or cement mantle in revision total hip arthroplasty.

OBJECTIVE

To present the institutional experiences of using a new and simple surgical technique to remove well-fixed femoral stem or cement mantle in revision total hip arthroplasty (THA).

MATERIAL AND METHOD

A retrospective chart review of patients who had revised total hip arthroplasty by the "railroad technique" between January 2007 and January 2009 at Orthopedics department, Khon Kaen hospital was done. The Railroad (long parallel) osteotomy was performed at proximal femur in patients who had complicated revision femoral stem or had removed cement mantle. Long revision stem was used together with the osteotomised bone fragment, which was fixed with cerclage wires. Outcomes of this technique were assessed based on the postoperatively revision stem stability, bone ingrowth, osteotomised bone fragment union, and complications.

RESULTS

Twenty railroad proximal femoral osteotomies in 19 patients were performed to remove femoral stem or cement mantle. Postoperative assessment showed good stability, evidence of bone ingrowth, and bone fragment union. No complications including infection, fracture, dislocation, or subsidence were reported.

CONCLUSION

Railroad technique used in the complicated femoral revisions provided great clinical outcomes with no complication. This evidence supports the practical use of railroad technique, which requires basic instruments to perform.