A new technique for cement plug removal in hip and knee arthoplasty exchange

Abstract

Removal of cement and especially the distal cement plug during cemented arthroplasty replacements is key to the success of the surgery, but can be challenging for the surgeon. The methods employed for this step can be very varied, ranging from removal with the aid of rasps, drills, ultrasonic techniques, to bone windows for direct access to the plug. These techniques can sometimes lead to perforation of the bone cortex and even to the production of uncontrolled fractures that prevent safe implantation of the new implant.The aim of this study is to review the different cement removal techniques and to evaluate the efficacy of a new technique, which allows the cement plug to be removed in a safe and controlled manner, avoiding the need for osteotomies. A customised guide is used for this purpose. This allows an effective and leak-free re-cementing of the new implants.We present 3 cases of distal cement removal using a customised guide that allows the cement plug to be broached. In all 3 cases, after cement removal, the implantation of longer stems with correct cementation was achieved.It should be noted that the target population in all cases is an elderly Spanish population, a population of short stature with curved femurs and poor bone quality; these characteristics make perforation and intraoperative fractures much more likely. However, in our two patients there were no cortical perforations. The mean time for plug removal was 22min. ConclusionThe use of customised guides for cement plug removal during cemented hip and knee arthroplasty replacement is safe and effective.