NDLI: Removal of well-fixed fixed femoral stems.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Laffosse, J-M
Description	Author Affiliation: Laffosse JM ( Département de chirurgie orthopédique, traumatologique et reconstructrice, hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France. Electronic address: jmlafos@gmail.com.)
Abstract	The removal of a well-fixed prosthetic stem raises technical challenges. The objective is not only to remove the material, but also to prepare the implantation of a new prosthesis. Cemented stems are only very rarely unremovable; extraction of the cement mantle and plug raises the greatest difficulties. The main risk is cortex perforation, and a radiograph should be obtained at the slightest doubt. The removal of cementless stems carries a higher risk of fracture. Difficulties should be anticipated based on thorough familiarity with the implant design and on evaluations of implant fixation and bone stock. The intramedullary approach is usually sufficient to extract a cemented or cementless, well fixed, standard stem. Routine use of a transfemoral approach is warranted only in the following situations: revision surgery for infection, S-shaped stem, long stem, curvature or angulation of the femoral shaft, or unfeasible hip dislocation. However, the possibility that the intramedullary approach may need to be converted to a transfemoral approach should be anticipated. Thus, preoperative planning must include determination of the optimal length of a femoral osteotomy or femoral flap, should one be needed, and the surgeon must have access to all the revision implants and tools that might be needed for re-implantation. Experience with the various techniques is indispensable, as a well-performed extensive approach is associated with less morbidity than a fracture or trajectory error. There are three main techniques, which are described here: intramedullary extraction of a cementless stem, intramedullary extraction of a cemented stem, and transfemoral extraction through an extended trochanterotomy. The patients should receive detailed information on the difficulties of femoral stem removal and on the available solutions.
File Format	HTM / HTML
Issue Number	1 Suppl
Volume Number	102
e-ISSN	18770568
Journal	Orthopaedics & Traumatology: Surgery & Research
Language	English
Publisher	Elsevier
Publisher Date	2016-02-01
Publisher Place	France
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Discipline General Surgery Discipline Traumatology Arthroplasty, Replacement, Hip Methods Device Removal Femur Surgery Prosthesis Failure Bone Cements Diaphyses Fractures, Bone Epidemiology Hip Prosthesis Humans Osteotomy Postoperative Complications Reoperation Surgical Flaps Journal Article Review
Content Type	Text
Resource Type	Article

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