Removal of an osteointegrated broken uncemented femoral stem after hip arthroplasty-technical note

Broken stems are particularly challenging in revision hip arthroplasty, as no standard extraction instruments fit anymore. Well-integrated uncemented stem remnants can be particularly arduous to remove. Stem fatigue failure is not rare with modular stems. Since these are particularly useful in revision hip arthroplasty, increasing numbers of broken stems are to be expected. Usually applied techniques using cortical fenestration distally to the tip of the stem or using an extended transfemoral approach cause supplementary bone defects impairing reconstruction. We present a relatively simple and reproducible revision technique, using a limited standard approach and only regular orthopedic instruments, to extract the remnants of broken uncemented femoral stems in hip arthroplasty. This technique was applied successfully and without complications in 6 cases, permitting eventually the reimplantation of even shorter stems.