Endoscopy for Cement Removal in Revision Arthroplasty of the Hip

One of the primary steps in revision hip arthroplasty is the extraction of retained components and cement before surgical reconstruction. In revision hip arthroplasty, the removal of well-fixed cement can be extremely demanding, time-consuming, and damaging to the remaining host bone1. A number of studies have shown the usefulness of endoscopy of the medullary canal to facilitate cement removal without performing a trochanteric osteotomy. Various endoscopy systems have been designed to visualize the endosteal surface of the bone2-5. Here we report on a multicenter prospective study on cement removal with standard available endoscopy equipment in both infected and uninfected hips undergoing revision arthroplasty (Fig. 1). The aims of our study were (1) to define the usefulness of and the quality of the view provided by standard available laparoscopic equipment, (2) to report on intraoperative complications during medulloscopy-assisted cement removal, (3) to define the risk factors for femoral perforation and intraoperative fracture, (4) to define the indications for and limitations of medulloscopy for cement removal, and (5) to perform a critical analysis of the completeness of cement removal, especially in revisions done in infected hips.