SURGICAL PEARLS: Femoral Component Removal in Revision THA
The secret to safe femoral component removal – with minimal bone loss, of course – is the exposure, Robert T. Trousdale told attendees at ICJR’s 8th Annual Revision Hip & Knee Course.
In about 30% of his revision total hip arthroplasty cases, Dr. Trousdale obtains exposure through a standard posterior approach, without an osteotomy. He can easily remove the implant from the top and has no need to access the canal distally. In addition, these patients have no major deformities that would impair his ability to place a straight femoral stem down the canal.
An osteotomy is necessary for adequate exposure, Dr. Trousdale said, when he needs to access the canal to remove cement and/or the implant or when the patient has a varus deformity or anterior bow. In those situations, he performs:
- A posterior extended trochanteric osteotomy (ETO) for a varus deformity
- A Wagner ETO for anterior bow issues
- A transfemoral ETO to address both varus deformity and an anterior bow, as in patients with poor bone stock or a periprosthetic fracture
To remove the femoral component, Dr. Trousdale uses extractors, a pencil-tip burr, and an oval or acorn burr to clear the greater trochanter while leaving as much bone as possible.
Click the image above to watch Dr. Trousdale’s presentation, including a surgical video demonstrating his techniques for femoral component removal in revision total hip arthroplasty.
Robert T. Trousdale, MD, is a Professor of Orthopaedics at Mayo Clinic, Rochester, Minnesota.
Disclosures: Dr. Trousdale has disclosed that he receives royalties from and is a paid consultant for DePuy Synthes.