Difficult Tibial Nail Removal using the “Extended Trochanteric Osteotomy†Technique Prior to Total Knee Arthroplasty

Abstract- Osteoarthritis of the knee may occur in patients who have previously undergone tibial nailing, necessitating nail removal in order to perform total knee arthroplasty. Typically, the nail may be removed without a great deal of difficulty, either as a separate procedure or at the time of the arthroplasty. However, tibial nail removal may pose a significant challenge. Extended trochanteric osteotomy is an exposure technique that provides optimal access to the femoral diaphysis.1 Creating a longitudinal window down the length of the femur exposes the intramedullary canal allowing for removal of well fixed components (such as fully coated pressfit stems) that are adherent to the bone. This technique has been well described in the literature with several variations of this procedure also now used quite universally.2 We report the use of a similar technique, extended tibial osteotomy, to remove an incarcerated tibial nail at the time of planned total knee arthroplasty. Our patient was informed that data concerning the case would be submitted for publication, and she consented.