Femoral stem extraction devices

• Published in: Archives of orthopaedic and trauma surgery 2024-12, Vol.145 (1), p.27, Article 27
• Main Authors: Khan, Shujaa T., Huffman, Nickelas, Walsh, Jonathan, Pasqualini, Ignacio, Piuzzi, Nicolas S., Deren, Matthew E.
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Device Removal - instrumentation; Device Removal - methods; Femur - surgery; Hip Prosthesis; Humans; Joint surgery; Medicine; Medicine & Public Health; Orthopedics; Reoperation; Review; Transplants & implants
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-024-05701-y

Introduction As the number of primary total hip arthroplasty (THA) procedures continues to increase, so too does the demand for revision surgery, with a 43–70% rise in revision THA anticipated by 2030. Femoral stem extraction in revision THA is particularly challenging and may lead to complications like femoral bone loss or fractures. However, increasing catalogue of femoral stems available for primary and revision THA has led technological advances in extraction devices to potentially overcome these limitations. This review aims to discuss the identification of femoral implants and the various femoral stem extraction devices currently available. Methods A scoping review of current literature was conducted to explore currently available femoral extraction devices. The devices not available in literature but used in clinical practice have also been included. This review focused on the technical components, advantages, and limitations of different femoral extraction tools, including osteotomes, reciprocating saws, high-speed burrs, trephines, and extraction systems like the Watson Extraction System, Exodus Revision Hip System, Shukla Hip Universal Stem Extraction System, and DePuy Synthes Extractors. Results Identifying femoral implants is a critical step in preoperative planning to allow for appropriate equipment to be available during revision surgery. The present review highlights that no single extraction device is universally applicable. Tools like flexible osteotomes, burrs, and trephines offer versatility but may risk bone damage. Advanced systems like the Watson Extraction System and Shukla Hip Universal Stem Extraction System provide more precise extraction, reducing the likelihood of cortical perforations and decreasing operative time. Conclusions Efficient femoral stem extraction in rTHA is essential for managing complications and preserving bone stock. While traditional tools remain valuable, the development of specialized extraction systems offers improved precision and efficiency. Preoperative planning, including accurate implant identification, and the selection of appropriate extraction devices are crucial for successful outcomes in revision hip arthroplasty.