Uncemented Tapered Fluted Stems
Robert T. Trousdale
Uncemented tapered fluted stems can provide durable fixation during primary total hip arthroplasty.
These stems are relatively simple to use as they require only reaming the canal until one achieves axial and rotational stability.
These stems are especially helpful in the face of excessive femoral version, coxa valga, and small femurs and in posttraumatic deformity (Figure 10.1).
Sterile Instruments and Implants
Routine hip retractors.
System specific tapered reamers to prepare canal.
System specific tapered trial implants.
Trial heads including 28 and 22 mm, as some of these patients will have very small acetabular components.
Surgical approach may be according to surgeon preference. This implant may be placed easily by various anterior, lateral, or posterior approaches.
Drape the whole or a majority of femur.
Position such that it is easy to get an intraoperative radiograph if desired.
Know patient’s preoperative leg length discrepancy.
Template cup size and position.
Template femoral component size on anteroposterior and lateral radiographs of the femur. Template the desired neck resection level.
Using the tip of trochanter as a secondary check for anticipated neck resection is helpful. In general, the tip of greater trochanter should be at the level of the center of the femoral head.
Bone/Implant/Soft Tissue Techniques
Perform desired approach to hip joint.
Perform femoral neck osteotomy according to the preoperative plan.
Prepare acetabulum, place cup with trial liner.
Figure 10.1 ▪ Anteroposterior radiograph of patient with left hip arthritis with proximal femoral deformity. Femur is in varus as well as has torsional malunion deformity.Premium Wordpress Themes by UFO Themes
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