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The Transtrochanteric Approach to the Total Femur Replacement: A Novel Technique

Nononcologic total femur replacement (TFR) secondary to periprosthetic fracture, aseptic loosening or infection has had many surgical approach options provided in the literature. No single approach has been proven to be superior in preventing postoperative complications due to its rare and complex nature, however. Therefore, we believe that a successful outcome following a previously undescribed approach for a TFR is valuable contribution to the current literature. Technique, in the following report, we present is a transtrochanteric approach to a TFR. This approach involved a vertical transtrochanteric osteotomy which allowed the anterior and posterior capsular and muscular attachments to the greater trochanter to be maintained. By doing this, we believe the stability was significantly improved. At 2-year follow-up, the patient has had a good functional outcome without complications. Pearls: (1) The use of a transtrochanteric osteotomy allows for increased stability of the hip. (2) A modular system for revision total knee arthroplasties can be beneficial for conversion to TFR. (3) A total femur hemiarthroplasty prevents the need for a constrained liner that has high long-term failure rates. (4) Vacuum-assisted closure systems can be used to help prevent postoperative edema and seroma formation.