Authors of section

Authors

Derek Donegan, Michael Huo, Michael Leslie

Executive editor

Michael Baumgaertner

Open all credits

Resection arthroplasty

1. Principles

Resection arthroplasty should be used for a joint that is not deemed as salvageable, most commonly due to infection or bone loss.

2. Approach

The surgeon should use the surgical approach that is the most familiar to him/her for any total hip arthroplasty, such as:

The patient is placed in a supine or a lateral position.

Note: the approach should be extensile in order to facilitate both femoral and acetabular component removal.

3. Resection

Removal of femoral stem: unstable component

Utilize fracture planes to disengage femur from prosthesis.

Removal of femoral stem: unstable component

Utilize available equipment (bone hook, pliers, vice grips, etc.) to engage the prosthesis and remove it.

Engage the prosthesis and remove it

Removal of femoral stem: stable component

Use bone tamp and mallet to disengage the femoral head from the Morse taper of the femoral prosthesis.

Removal of femoral stem: stable component

If the stem is uncemented, utilize available equipment (flexible osteotomes, pencil tip burr, microsagittal saw, etc.) to disrupt the stem/femur interface.

Disrupt the stem/femur interface

Once the stem/femur interface is fully disrupted, proceed with stem removal, utilizing extraction equipment (bone hook, pliers, vice grips, slap hammer, etc.)

Proceed with stem removal

If unable to fully disrupt stem/femur interface, or if a cemented stem is in place, proceed to an extended trochanteric osteotomy by extending the fracture line distally.

Extended trochanteric osteotomy

Femoral fixation

Stabilize with cerclage or remove loose bone fragments.

4. Aftercare

Physiotherapy guidelines

Protective weight bearing is recommended indefinitely.

Imaging

Follow-up radiographs should be per surgical protocol.