Authors of section

Authors

Derek Donegan, Michael Huo, Michael Leslie

Executive editor

Michael Baumgaertner

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Femoral stem removal

1. General considerations

Consideration should be made to perform an extended trochanteric osteotomy (ETO). This will minimize surgical trauma and expedite stem and cement extraction.

2. Cemented stem removal

Cemented stem removal requires proper tools, such as the cement removal osteotomes and the reverse hooks.

Cement removal osteotome

On occasion, high-speed burr may be necessary.

High-speed burr

The universal stem extraction tools system is very helpful in removing both cementless and cemented stems.

Universal stem extraction tools system

The loose stem is pulled out with the universal stem extraction tools system. Tool selection depends on the stem design and surgeon's preference.

Universal stem extraction tools system

The well-fixed stem is more problematic. The interface between the stem and cement must be disrupted with flexible osteotomes prior to extraction.

Extraction of a well fixed stem

Residual cement after stem removal can be removed with the cement removal osteotomes and reverse hooks.

If available, ultrasonic devices can be used to disrupt cement mantle.

The cement restrictor must be dislodged or removed. This can be performed with a guide pin inserted in the middle of the plug followed by cannulated reamers to fragment the device.

Removal of residual cement

On occasion, high-speed burr may be necessary.

High-speed burr

3. Cementless stem removal

Cementless stem removal is most facile if the surgeon has the proper extraction tools available from the specific device manufacturer.

The bone-implant interface should be disrupted prior to forceful stem removal with the extraction devices.

Flexible osteotomes are used to disrupt the bone-implant interface around the stem.

Flexible osteotomes system

Different lengths and diameters of the osteotomes should be used dependent upon the stem geometry.

Stem removal with a flexible osteotome

The universal stem extraction tools system is very helpful in removing both cementless and cemented stems.

Universal stem extraction tools system

The loose stem is pulled out with the universal stem extraction tools system. The best tool to be used depends on the stem design and surgeon's preference.

Universal stem extraction tools system for femoral stem removal