- removal of broken femoral stems:
- removal of cementless stems:
- removal of cemented femoral stems:
- as noted by Peters, et al. (1997), at the time of acetabular component revision, evidence supports leaving a well fixed cemented component in place;
- in femoral components inserted w/ first generation cementing techniques, the rate of mechanical failure was 22% at 5 years following the acetabular component revision;
- 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;
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
- Femoral windows in revision total hip arthroplasty.
- The Fate of Well Fixed Cemented Femoral Components Left in Place at the Time of Revision of the Acetabular Component.
- Preparation of the proximal femur in cementless total hip revision.
- Modular Femoral Stem Removal During Total Hip Arthroplasty Using a Universal Modular Stem Extractor.