‘Rail Road’ Proximal Femoral Osteotomy: A New Technique to Remove Well-Fixed Femoral Stem or Cement Mantle in Revision Total Hip Arthroplasty
Kriangsak Piyakunmala MD*, Thananit Sangkomkamhang MD*, Keerati Chareonchonvanitch MD**
Affiliation : * Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand ** Department of Orthopaedics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To present the institutional experiences of using a new and simple surgical technique to remove
well-fixed femoral stem or cement mantle in revision total hip arthroplasty (THA).
Material and Method: A retrospective chart review of patients who had revised total hip arthroplasty by the
“railroad technique” between January 2007 and January 2009 at Orthopedics department, Khon Kaen
hospital was done. The Railroad (long parallel) osteotomy was performed at proximal femur in patients who
had complicated revision femoral stem or had removed cement mantle. Long revision stem was used together
with the osteotomised bone fragment, which was fixed with cerclage wires. Outcomes of this technique were
assessed based on the postoperatively revision stem stability, bone ingrowth, osteotomised bone fragment
union, and complications.
Results : Twenty railroad proximal femoral osteotomies in 19 patients were performed to remove femoral stem
or cement mantle. Postoperative assessment showed good stability, evidence of bone ingrowth, and bone
fragment union. No complications including infection, fracture, dislocation, or subsidence were reported.
Conclusion : Railroad technique used in the complicated femoral revisions provided great clinical outcomes
with no complication. This evidence supports the practical use of railroad technique, which requires basic
instruments to perform.
Keywords : Railroad, Proximal femoral osteotomy, Revision total hip arthroplasty, Remove femoral stem, Well fixed femoral stem, Technique remove stem
