Technical Note for Transfemoral Implantation of Tapered Revision Stems. The Advantage to Stay Short

BACKGROUND: The aim was to test the hypothesis that during transfemoral implantation of a conical revision stem, the fixation of the stem at the distal tip leads to a low rate of periprosthetic fractures. MATERIAL AND METHODS: Two hundred eighty-two stem revisions by a transfemoral approach in cases of Paprosky Type II and IIIA-defects (with a sufficient isthmus) were carried out and analyzed during and radiographically after the surgery for unintentional periprosthetic fractures below the osteotomy. RESULTS: In all cases, fixation was always achieved at the tip of the distal component in the isthmus of the femur. No periprosthetic fractures were observed. CONCLUSIONS: When the isthmus of the femur is intact, a transfemoral implantation of a tapered revision stem at the distal end reduces the risk of periprosthetic fractures by preventing bypassing the isthmus with the stem. Knowing the difference between the nominal diameter and the diameter at the distal start of the conical zone can help to create this fixation technique resulting in short revision stems.