During revision total hip arthroplasty, the femoral stem is a long, extensively porous-coated implant that is completely osseointegrated and cannot be removed by standard extraction techniques. Which exposure technique is specifically designed for this situation?

• A Trochanteric slide osteotomy
• B Femoral cortical window created distal to the stem tip
• C Anterior Hueter approach with capsulectomy
• D Extended trochanteric osteotomy through the lateral cortex and anterior femoral flap ✓

Explanation

The extended trochanteric osteotomy divides the lateral femoral cortex and elevates an anterior cortical cancellous flap along roughly one-third to one-half of the femur, allowing direct access to the ingrown stem surfaces so it can be freed and removed while preserving soft tissue attachments and vascularity for later fixation. A cortical window distal to a well-fixed stem risks fracture and does not expose the porous coating. Trochanteric slide improves exposure only, not access to a diaphyseally fixed stem.

Reference: Miller's Review of Orthopaedics, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.