Figure 2

Then controlled fractures of the proximal femur are generated with osteotomes. They may extend from the osteotomy site distally to, as far as needed, proximally to facilitate the stem removal, but not closer than 2 cm from the vastus ridge. The continuity of the abductors with the vastus lateralis and the GT with the lesser trochanter is thus retained. Normally, this extent of fragmentation of the femur is enough for the removal of the old prosthesis, as the area of remaining fixation is usually distal and proximally the prosthesis is loose. If, however, there are still areas of proximal bone ingrowth or when a stable implant is revised, the posterior aspect of the intertrochanteric region can be violated to facilitate the stem removal, as long as the trochanteric continuity is retained anteriorly. After stem removal, the canal preparation and the revision prosthesis insertion are performed under direct vision.