A modified technique to extract fractured femoral stem in revision total hip arthroplasty: A report of two cases

Abstract

INTRODUCTIONThe removal of well-fixed broken femoral component and cement mantle can be extremely demanding, time consuming and potentially damaging to the host bone. Different methods have been described to extract broken femoral stem yet this remains one of the most challenging prospect to the revision hip surgeon.PRESENTATION OF CASEThe authors present two cases underwent a modified sliding cortical window technique utilising a tungsten carbide drill, Charnley pin retractor and an orthopaedic mallet to aid extraction of a fractured cemented femoral stem in revision total hip arthroplasty.DISCUSSIONThe modified technique offers a simple and controlled method in extracting a well fixed fractured cemented femoral stem. It has the advantage of retaining the cement mantle with subsequent good seal of the femoral cortical window secured with cable ready system. Furthermore, tungsten carbide drill bit and Charnley pin retractor are relatively readily available to aid the extraction of the broken stem. Finally, it yields the option of implanting a standard femoral stem and obviates the need for bypassing the cortical window with long revision femoral component.CONCLUSIONFractured femoral stem is a rare yet a complex and very demanding prospect to both patients and hip surgeons. The sliding cortical window technique utilising tungsten carbide drill and Charnley pin retractor is technically easy and most importantly; preserves host bone stock with cement-in-cement revision hip arthroplasty. We believe this technique can be added to the armamentarium of revision hip surgeon when faced with the challenge of extracting a fractured cemented femoral stem.

A minimally invasive technique to remove broken cemented stems and its reconstruction with cement-in-cement

“…3,4 Moreland et al 5 have described a technique that requires a femoral window to access the distal portion of the broken femoral stem to perform retrograde impaction. Akwari et al 6 described a variant of this technique in 2 patients, but performing reconstructions with standard stems and a cement-in-cement technique. In both, it was necessary to gain access to the proximal femoral region and the distal fragment, which implies an extensile approach and the generation of an area of bone weakness.…”

“…In both, it was necessary to gain access to the proximal femoral region and the distal fragment, which implies an extensile approach and the generation of an area of bone weakness. 6 The use of a knee arthrotomy with a retrograde endomedullary nail for the impaction of the distal part of the stem has also been described for selected cases. 7 The technique described in this paper is a modification of previously published methods by 2 different authors.…”

“…In both, it was necessary to gain access to the proximal femoral region and the distal fragment, which implies an extensile approach and the generation of an area of bone weakness. 6…”

Anterolateral Bone Window for Revision Broken Cemented Stem of Unipolar Hemiarthroplasty

“…Removal of the distal part of a well-fixed broken cemented stem is a challenging procedure. Many techniques have been described, such as femoral bone window distal to the tip of the stem, extended trochanteric osteotomy, knee arthrotomy to push the distal part, and minimally invasive technique through the drilling of the proximal surface of the retained part of the stem and attachment of a threaded extraction device and a proximal femoral cortical window [ 6 , 7 ]. In this series, we analyzed revision of the well-fixed broken stem of cemented Thompson hemiarthroplasty using anterolateral proximal femoral window without the need of extended trochanteric osteotomy.…”

Three Cases of Femoral Stem Failure in Rotating Hinge Revision Total Knee Arthroplasty: Causes and Surgical Considerations

“…The number of revision total knee arthroplasty (TKA) procedures performed annually is steadily increasing. 1 2 3) This number is likely to continue to increase. 4) Stemmed prostheses are frequently used in the revision setting in order to provide stable adjunctive diaphyseal fixation in cases with suboptimal bone stock.…”