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Updated: Jun 5, 2025
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Femoral stem extraction devices
Shujaa T Khan1, Nickelas Huffman1, Jonathan Walsh1
1Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
Insights
Revision hip arthroplasty requires effective femoral stem extraction. Specialized systems offer improved precision and efficiency, crucial for successful outcomes and bone preservation in revision total hip arthroplasty (THA).
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Implant retrieval
Background:
- Rising rates of primary total hip arthroplasty (THA) predict a significant increase in revision THA procedures by 2030.
- Femoral stem extraction during revision THA presents considerable challenges, including risks of bone loss and fracture.
- Technological advancements in extraction devices aim to mitigate these challenges.
Purpose of the Study:
- To review available femoral stem extraction devices for revision total hip arthroplasty (rTHA).
- To discuss implant identification and the technical aspects of various extraction tools.
Main Methods:
- A scoping review of existing literature on femoral extraction devices.
- Inclusion of devices used in clinical practice but not extensively published.
- Focus on technical features, benefits, and drawbacks of tools like osteotomes, saws, burrs, trephines, and specialized extraction systems.
Main Results:
- Accurate identification of femoral implants is vital for preoperative planning in rTHA.
- No single extraction device is universally suitable for all cases.
- Advanced systems (e.g., Watson, Shukla) enhance extraction precision, reduce operative time, and minimize cortical perforations compared to traditional tools.
Conclusions:
- Effective femoral stem extraction in rTHA is key to managing complications and preserving bone stock.
- Specialized extraction systems provide enhanced precision and efficiency over traditional instruments.
- Thorough preoperative planning, including implant identification and appropriate device selection, is paramount for successful revision hip arthroplasty outcomes.
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.
