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THR Revision: Removal of Femoral Stem

Discussion

Surgical Exposure

  • it is essential that prior to attempted femoral component removal, that there is a clear retrograde path for stem removal;
    • this exposure is essential to clearly visualize the lateral bone-cement interface, which could otherwise risk trochanteric fracture;
    • this means that any trochanteric overhang is removed, either with a high speed bur or with an trochanteric osteotomy:
    • trochanteric frx, is especially indicated w/ press fit stems that have a collar;

Extraction Instruments »

Initial Attempt at Extraction

  • after adequate exposure has been established, attempt to remove the femoral component w/ several slaps of the slap hammer (w/ universal extractor);
    • alternatively, clear away enough bone under the proximal collar to allow enough space to allow an impaction rod underneath the collar;
  • if the prosthesis does not move w/ several blows of the slap hammer, then the prosthesis is stable, and will require disruption of the bone-prosthesis or the bone-cement interface

Removal of the Stable Prosthesis

References