Revision surgery for failed, nonseptic total hip arthroplasty: the femoral side.

The rapidly increasing incidence of femoral failure after total hip arthroplasty has forced the generation of numerous major techniques to treat this complication effectively. Extraction of a femoral component that is not grossly loose is vastly facilitated by a new femoral component extractor. Cement removal has been made much simpler and safer with the use of a medullary canal guide, a fiberoptic headlight, and wide exposure of the proximal femur by release of the iliopsoas, the vastus lateralis, and the intermedius, and more effective using Depuy drills, rigid Kunshcher rods, and an ordinary power source. A new technique developed for removing broken femoral stems uses the Midas Rex to drill a hole in the metal, undercutting the metal and extracting the broken tip through the femoral neck. This technique eliminates the need for a window and the requirement for long-stem prosthesis. Special components are required for specific problems in bone loss, including devices that replace a deficient calcar femorale, as well as more common long-stem and proximal femoral replacement implants. In circumstances of massive bone loss in the proximal part of the femur, techniques for allografting entire femoral segments have been effective. These innovations play a major role in reducing the technical complications with revising a failed femoral component after total hip arthroplasty and obtaining excellent functional restoration.