Note: the approach should be extensile in order to facilitate both femoral and acetabular component removal.
Exposure of the acetabular component
Place retractors to expose the acetabulum.
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.
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
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.
Remove the screws and then remove the component with available equipment (bone hook, pliers, vice grips, Kocher, etc.).
Protective weight bearing is recommended indefinitely.
Follow-up radiographs should be per surgical protocol.