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. 2024 Dec 12;145(1):27.
doi: 10.1007/s00402-024-05701-y.

Femoral stem extraction devices

Shujaa T Khan  1 , Nickelas Huffman  1 , Jonathan Walsh  1 , Ignacio Pasqualini  1 , Nicolas S Piuzzi  1 , Matthew E Deren  2
Affiliations

Femoral stem extraction devices

Shujaa T Khan et al. Arch Orthop Trauma Surg. .

Abstract

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.

Keywords: Devices; Extraction; Femoral stem; Hardware; Removal; Tools.

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Conflict of interest statement

Declarations. Competing interests: Authors 1, 2, 3 and 4 have no competing interests to declare. Author 5 has the following disclosures not related to the present study. American Association of Hip and Knee Surgeons: Board or committee member. ISCT: Board or committee member. Journal of Hip Surgery: Editorial or governing board. Journal of Knee Surgery: Editorial or governing board. Orthopaedic Research Society: Board or committee member. Osteal Therapeutics: Research support. Pacira: Paid consultant. Peptilogics: Research support., RegenLab: Research support. Signature Orthopaedics: Research support. Stryker: Paid consultant. Zimmer: Research support. Author 6 has the following disclosures not related to the present study. Brasseler: Paid presenter or speaker. RomTech: Stock or stock Options.

References

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