Lateral Femoral Corticotomy to Facilitate Partial Removal of an Intramedullary Stem of an Endoprosthetic Reconstruction: Making a Difficult Situation Into a Straightforward Surgery

Introduction: Periprosthetic fractures adjacent to long-stemmed endoprosthetic reconstructions pose a significant treatment challenge. Limited bone stock and extraction of intramedullary components create a technically difficult problem, usually treated by corticotomies, joint-sacrificing procedures, or total femur replacements. Materials and Methods: We present the case of a 71-year-old female with a history of MRSA-infected knee arthroplasty who presented with a periprosthetic femoral neck fracture treated with a novel osteotomy and partial stem excision using a push-out technique. This technique was developed to facilitate ipsilateral hip arthroplasty without joint violation in the setting of an increased risk of infection. Results: The patient was followed for 2 years postoperatively, and PROMIS scores were obtained both preoperatively and postoperatively. The patient achieved independent ambulation and satisfactory functional outcomes. The patient had no infection recurrence and continued functional independence, evidenced by stable implant positioning and improved PROMIS scores. Discussion: We present this technique as an option for complex, multiply-operated patients who have undergone endoprosthetic reconstruction with limited available bone stock.