Effectiveness of Cortical Window Technique for Revision Hip Arthroplasty

Background: Revision total hip arthroplasty requires removal of cement, cement restrictor and stem followed by canal preparations and reaming. Extraction of femoral component is a challenging problem. There are many techniques being used and described in the literature with all having associated with them. We reviewed the effectiveness of new cortical window method for femoral stem extraction in revision hip arthroplasty. Material and methods: We retrospective reviewed the result of all our patients operated for revision total hip arthroplasty by cortical window creation in diaphysis of femur for extraction of femoral stem. Window size ranged of 2.5 cm x 5 cm to 2.5 x 7.5cm. We analysed the results for age, indication and type of surgery, size and method of closure of cortical window etc. Outcomes recorded were assessed on pain and mobility. Results: 13 patients with mean age 76 years (range 60 to 88) with mean time duration of revision surgery with 12.5 years (range 5 to 25 years) were included in study. In 11cases femoral stems (85%) were extracted very easily while in 2 cases it was difficulty. In all cases, except one, the size of cortical window was 2.5 cm x 5 cm. In 10 cases, cable wires were used to fix the cortical window, were as in 3 cases of peri-prosthetic fractures additional plates were used. At 6 months 7 (54%) patients were pain free and 5 (38 %) of patients had mild pain. All patients had good mobility with able to do all daily routine work comfortably. Conclusion: Cortical window is an acceptable technique which can be used during revision total hip replacement. It can be performed in any age regardless of indication of revision. It reliably allows surgeon to prepare canal by removing all components