Authors of section

Authors

Derek Donegan, Michael Huo, Michael Leslie

Executive editor

Michael Baumgaertner

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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

Exposure of the acetabular component

Place retractors to expose the acetabulum.

Exposure of the acetabular component

Acetabular component without screws

If acetabular component is not secured with screws, remove component with available equipment (bone hook, pliers, vice grips, Kocher, etc.) to engage the prosthesis and remove it.

Removal of an acetabular component without screws

Acetabular component secured with screws

If acetabular component is secured with screws, remove the polyethylene portion to expose the screws.

There are two commonly used techniques for bearing removal:

  • Use of an osteotome at the liner-shell junction to lever and to remove the liner
Liner removal
  • Use a threaded extraction tool or cancellous screw to push out the liner

In the event neither technique is successful, the liner should be sectioned with a high-speed burr in order to access the screws. Forceful extraction of the cup with the screws in place will result in major disruption of the acetabulum and substantial neurovascular injury.

Threaded extraction tool for liner removal

Remove the screws and then remove the component with available equipment (bone hook, pliers, vice grips, Kocher, etc.).

Acetabular screw removal

4. Aftercare

Physiotherapy guidelines

Protective weight bearing is recommended indefinitely.

Imaging

Follow-up radiographs should be per surgical protocol.