Fenestration of the femoral shaft: a standard procedure in revision hip surgery without bypassing the cortical defect.

In revision hip arthroplasty, implant retrieval and residual bone cement removal may be major problems. Complete removal of the bone cement is key for the stable anchorage of the revision stem. As proximal access does not always provide an optimal view, fractures or inadvertent perforations of the cortical bone with the chisel or drill are frequently reported complications.1-3 Windowing of the femoral shaft facilitates the procedure and ensures greater accuracy.1,4-7 Although it may weaken the femoral shaft and thus increase the risk of postoperative femoral fractures, the revision stem should bypass the window distally by at least twice the diaphyseal width.4,6-10 We have not followed this recommendation because we believe bridging of the cortical defect by 4-5 cm is irrelevant. As our technique is controversial to the literature, we have analyzed its clinical and radiographic outcome.