Femoral cement removal in revision total hip arthroplasty. A biomechanical analysis

A technique of femoral cement removal in revision total hip arthroplasty is described and biomechanically evaluated. Two 9-mm holes are drilled anteriorly through the proximal femoral cortex before cement is removed. These holes permit direct visualization of the medullary canal and help to prevent eccentric reaming or inadvertent perforation with the power drill. They also provide portals for enhanced irrigation, illumination, and cement removal. For assessment of the effect of cortical perforations on bone strength, 12 cadaveric femurs containing cemented prosthetic stems were analyzed. The femurs were stressed at various loads on the Instron Materials Testing Machine (Instro Engineering Corporation, Kenton, MA) under conditions simulating single-limb stance. The stress concentrations were significantly higher about laterally drilled holes than about those located anteriorly. When loaded to failure, all fractures occurred at or below the prosthetic stem tip. No fractures occurred in the proximally placed drill holes. A finite element model showed that two holes kept at least two hole diameters apart did not cause cumulative stress concentration.