Abstract
Broken stems are particularly challenging in revision hip arthroplasty, as no standard extraction instruments fit anymore. Well-integrated uncemented stem remnants can be particularly arduous to remove. Stem fatigue failure is not rare with modular stems. Since these are particularly useful in revision hip arthroplasty, increasing numbers of broken stems are to be expected. Usually applied techniques using cortical fenestration distally to the tip of the stem or using an extended transfemoral approach cause supplementary bone defects impairing reconstruction. We present a relatively simple and reproducible revision technique, using a limited standard approach and only regular orthopedic instruments, to extract the remnants of broken uncemented femoral stems in hip arthroplasty. This technique was applied successfully and without complications in 6 cases, permitting eventually the reimplantation of even shorter stems.
Highlights
We present a relatively simple technique for extraction of broken femoral stem remnants in revision total hip arthroplasty (THA) (rTHA), using a limited standard exposure and standard instruments
Surgical technique Revision is performed in a lateral position through a transfemoral approach [15, 16]
A cerclage should be in place around the intact diaphysis just distally to the osteotomy, to avoid fractures during extraction as well as during impaction of the new Discussion Fatigue failure of the femoral stem is a known issue in hip arthroplasty [1,2,3,4]
Summary
Fracture of the femoral stem accounts for approximately 1% of revisions after primary total hip arthroplasty (THA) [1,2,3]. Introduction Fracture of the femoral stem accounts for approximately 1% of revisions after primary total hip arthroplasty (THA) [1,2,3]. Modular stems have a much higher associated fracture rate [5]. While modularity offers advantages over monobloc stems regarding reliability of the reconstruction and functional results in rTHA [6,7,8], worrisome incidences of stem fractures have been reported, at least for certain models [5, 6, 9,10,11].
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