Removal of well-fixed fixed femoral stems

Orthopaedics & Traumatology, Surgery & Research : OTSR
J-M Laffosse

Abstract

The removal of a well-fixed prosthetic stem raises technical challenges. The objective is not only to remove the material, but also to prepare the implantation of a new prosthesis. Cemented stems are only very rarely unremovable; extraction of the cement mantle and plug raises the greatest difficulties. The main risk is cortex perforation, and a radiograph should be obtained at the slightest doubt. The removal of cementless stems carries a higher risk of fracture. Difficulties should be anticipated based on thorough familiarity with the implant design and on evaluations of implant fixation and bone stock. The intramedullary approach is usually sufficient to extract a cemented or cementless, well fixed, standard stem. Routine use of a transfemoral approach is warranted only in the following situations: revision surgery for infection, S-shaped stem, long stem, curvature or angulation of the femoral shaft, or unfeasible hip dislocation. However, the possibility that the intramedullary approach may need to be converted to a transfemoral approach should be anticipated. Thus, preoperative planning must include determination of the optimal length of a femoral osteotomy or femoral flap, should one be needed, and the surgeon must have a...Continue Reading

References

Feb 1, 1996·The Journal of Arthroplasty·E D NaborsB E Bierbaum
Jul 31, 2013·Orthopaedics & Traumatology, Surgery & Research : OTSR·J GirardUNKNOWN Société française de chirurgie orthopédique et traumatologique
Jul 31, 2013·Orthopaedics & Traumatology, Surgery & Research : OTSR·N ReinaUNKNOWN Société française de chirurgie orthopédique et traumatologique
Aug 21, 2013·Orthopaedics & Traumatology, Surgery & Research : OTSR·P WodeckiI Semaan
Jan 3, 2015·Orthopaedics & Traumatology, Surgery & Research : OTSR·L Kerboull

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Citations

Mar 16, 2021·Journal of Clinical Orthopaedics and Trauma·Babaji ThoratRajeev Vohra
Mar 28, 2021·Journal of Orthopaedic Surgery and Research·Peter WahlEmanuel Gautier
May 19, 2021·Journal of Orthopaedic Surgery and Research·Amit SinghNicholas Charalambous
Aug 21, 2021·Journal of the Mechanical Behavior of Biomedical Materials·Christopher Butler RansohoffPeter Wahl

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