Abstract
A major concern during revision hip arthroplasty is acetabular bone loss and bleeding during the extraction of well-fixed cementless acetabular cup, because no interface exists between the host bone and the cup. Forceful removal of such component using curved gouges and osteotomes often leads to extended bone loss and compromises reimplantation of a new socket.In the following case report, we removed a well-fixed polyethylene titanium-coated RM acetabular cup with 20 years of follow-up, by significant wear of the polyethylene layer. The isoelastic femoral stem was also removed by mechanical failure.We report a technique for removal of the cementless acetabular cup using powered acetabular reamers. The RM cup was sequentially reamed and when the polyethylene layer was thin enough, the remaining cup was removed easily by hand tools. The acetabular bone stock is preserved and the risks of bone fractures and bleeding are minimized. To our knowledge, these principles were applied only in cemented cups.We have used this technique in 10 cases with excellent results and no complications were noted. This is a simple, reproducible, non-costly, non-timing consuming, safe and successful technique to remove well-fixed titanium-coated RM acetabular cups.
Highlights
The purpose of revision hip arthroplasty is to reconstruct the hip to reproduce, as closely as possible, the form and function of the native joint
Component removal in total hip arthroplasty revision is a crucial and essential step in the operation because it dictates the possibilities for component reimplantation and reconstruction, and of the patient outcome
We describe a technique to remove a well-fixed polyethylene titanium-coated RM cup using acetabular reamers, in a revision total hip arthroplasty
Summary
The purpose of revision hip arthroplasty is to reconstruct the hip to reproduce, as closely as possible, the form and function of the native joint. The indications for revision include significant polyethylene wear, fractures of the components, component malposition, hip instability, severe thigh pain, excessive damage to the femoral Morse taper, and severe infection [1,2,3]. The removal of well-fixed cementless components can be extremely demanding, time consuming, and requiringes patience and caution to limit the amount of host bone destruction. Component removal in total hip arthroplasty revision is a crucial and essential step in the operation because it dictates the possibilities for component reimplantation and reconstruction, and of the patient outcome. The implant industry has responded accurately to the needs of the revision surgeon and developed instruments to overcome such issues with less effort [6]
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