REMOVING WELL-FIXED CEMENTLESS COMPONENTS: TIPS FOR THE TRADE

Indications for removal of well-fixed cementless femoral components include infection, improper femoral height/offset/anteversion, and fracture. More recently, removal of well-fixed but recalled femoral components that are associated with adverse local tissue reaction (ALTR) has created a new indication for this procedure. The goal in all cases is to preserve bone stock and soft-tissue attachments to the greatest extent possible during implant removal. The strategy for implant removal depends to a large extent on the type of implant to be removed. Implants with limited proximal fixation can often be removed from the top using narrow osteotomes. Implants with more extensive fixation typically require more extensive exposure. When performing an extended trochanteric osteotomy, plan for the bone flap length based on measurement from the tip of the greater trochanter. Instead of devascularising the lateral bone flap, be sure to preserve the quadriceps attachment to the bone flap, exposing the lateral femur on...