Total hip revision arthroplasty. Prosthesis and cement removal techniques

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering

Background:

• Total hip arthroplasty (THA) often requires revision surgery.
• Removal of cemented components and polymethylmethacrylate (PMMA) bone cement presents significant challenges.
• Existing methods can be time-consuming and carry risks of component or bone damage.

Purpose of the Study:

• To present a modified, safer, and more efficient technique for removing cemented total hip arthroplasty components.
• To address the limitations of current cement removal methods, particularly tool dulling.

Main Methods:

• Utilized a modified technique employing manual instruments and low-speed drills, reamers, and end mills.
• Developed modular tools with replaceable working tips made of high-speed, hardened stainless steel to overcome tool dulling.
• Implemented a step-cut cement removal strategy and fixed-point orientation for the distal cement column.

Main Results:

• The modified technique demonstrated enhanced safety and predictability.
• Shorter learning curves were observed for surgeons adopting the technique.
• The method proved cost-effective due to tool design and efficiency.

Conclusions:

• The presented technique offers a safe, predictable, and cost-effective solution for removing cemented hip arthroplasty components.
• Modular tool design effectively mitigates issues with tool wear against methylmethacrylate.
• The step-cut and fixed-point orientation strategies further improve procedural safety and efficacy.