A Simple Technique to Remove Well Fixed Porous Cementless Acetabular Component in Revision Total Hip Arthroplasty

Garneti N,Saunders Isobel

doi:10.36959/453/566

Abstract

Removing well-fixed porous cementless acetabular components in revision Total Hip arthroplasty can be a surgical challenge for Orthopaedic surgeons. Forceful removal can result in loss of bone stock. Acetabular wall fracture is a real risk associated with extracting well-fixed cementless acetabular components, especially with certain instruments. Extraction of a well-fixed porous cementless acetabular component with relative ease can be achieved with the technique described.

Highlights

The most commonly used cementless acetabular components are porous, modular, hemispherical, press-fit or line-toline-fit metallic shells with polyethylene, metal or ceramic liners locked into the metal shell
Several techniques have been described for the extraction of cementless acetabular components
Et al described a technique of drilling a tunnel on the postero-superior quadrant of acetabulum, from the bone cortex to the surface of acetabular metal cup [11]. Whilst this technique may seem relatively simple, it can result in weakening of the posterior wall of the acetabulum. It could result in a significant amount of bone loss, posterior acetabular wall fracture, as the implant-bone interface is not disrupted before extraction of a cementless acetabular component

Summary

Introduction

The most commonly used cementless acetabular components are porous, modular, hemispherical, press-fit or line-toline-fit metallic shells with polyethylene, metal or ceramic liners locked into the metal shell. The design of the instruments and their ability to disrupt the bone-implant interface safely will have an impact on the degree of host bone destruction and the incidence of wall fractures during acetabular component extraction in revision hip surgery. I describe a technique to extract a well-fixed cementless porous acetabular component using simple instruments to disrupt the implant-bone interface, making it easy to extract the acetabular component. The acetabular component is tapped in a clock-wise/ anti-clockwise direction and in a retrograde manner using a sharp or a blunt osteotome with a serrated tip (Figure 3a, Figure 3b, Figure 3c and Figure 3d) These maneuvers should disrupt the implant-bone interface with no bone loss or fractures of the acetabular walls. The key to successful extraction of the porous acetabular component is the safe disruption of the bone-implant interface

Discussion

Summary