Retrograde stem removal in revision hip surgery: removing a loose or broken femoral component with a retrograde nail

Introduction

Removal of a cemented femoral stem during revision total hip arthroplasty is a technically demanding procedure that requires a multitude of surgical techniques and tools. To gain full access to the cement and the stem, distal fenestration or a transfemoral approach is often required. This paper presents a technique of retrograde removal of femoral stems and cement from the distal femur.

Materials and methods

The authors present five clinical cases. In two cases the femoral component and the surrounding cement was removed using this technique. In the other three cases, due to femoral component fracture, the distal fragment of the femoral component with its cement mantle was removed using the same technique. In an experimental study, we simulated the above technique and compared it with a windowing technique on six, paired cadaveric femora (12 femurs in all).

Results

In all of the clinical cases the stem and the cement were removed completely without any complications. The cadaveric experiments clearly showed that the biomechanical resistance of the femur against compression and torsion forces is greatly decreased by using a window to access the proximal femur, compared with the retrograde technique, which shows no significant change.

Conclusion

Retrograde component removal provides a simple, rapid, and less invasive technique for stem and cement extraction in elective revision hip arthroplasty.