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Two Techniques for Removal of a Recalled, Well Fixed, Dual Tapered, Modular Neck Femoral Stem

March 15, 2015

Contributors: Darwin Chen, MD; Mitchell Weiser, MD; Mitchell Weiser, MD

Recently, a widely used modern hip arthroplasty femoral component was recalled due to corrosion arising from its neck-body modular junction, leading to formation of an adverse local tissue response. This stem was designed as a "fit and fill," dual tapered, proximally plasma sprayed femoral implant and features a modular neck intended to more accurately restore femoral anatomy. The stem's body and modular neck are intentionally dissimilar metals (titanium-molybdenum-zirconium-iron alloy and cobalt-chromium-alloy, respectively). In this video, we present two techniques for safe and effective removal of this femoral component during revision total hip arthroplasty (THA).

1. Extended trochanteric osteotomy (Paprosky, J Arthroplasty 1995) - An osteotomy of the lateral one-third of the proximal femur, typically 9-12cm in length, is performed with preservation of the abductor and vastus lateralis muscular attachments. Extended trochanteric osteotomy (ETO) provides optimal internal exposure of the bone-prosthesis interface for component removal. This is an established, reliable, and reproducible technique for removal of any well fixed femoral stem, however adds morbidity and other potential complications, as well as increases rehabilitation time.

2. Steinman pin technique (Garino, J Arthroplasty 2013) - We have modified this technique from its original description to accommodate the design of this particular implant. A high speed thin pencil tipped burr is used to disrupt the visible proximal bone-prosthesis interface. Multiple 2.0mm smooth Steinman pins are then drilled around the circumference of the implant. Flexible straight and radial osteotomes are used to complete the removal process. This technique allows for component removal without osteotomy, but is technically demanding and can increase operative times.

It is the authors' opinion that most cases requiring removal of this femoral stem can be performed with the modified Steinman pin technique. Meticulous technique must be exercised in order to avoid iatrogenic damage. However, in the face of thin femoral cortices and/or osteoporotic bone, extended trochanteric osteotomy is our preferred technique, as the risk of fracture and/or cortical perforation is higher in these cases if an ETO is not performed.

Results for "Revision Hip Arthroplasty"

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