Powered Versus Manual Acetabular Component Extraction in Revision Total Hip Arthroplasty: A Comprehensive Analysis of
Dimitri Mabarak1, Shujaa T Khan1, Khaled A Elmenawi1
1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Background:
Revision total hip arthroplasty (R-THA) often requires removal of well-fixed acetabular components, where minimizing bone loss and operative time are critical. While manual extraction tools have been the traditional approach, powered systems device may improve efficiency, yet comparative clinical data remain limited.
Methods:
We performed a retrospective review of 98 R-THAs (32 powered, 66 manual) from an institutional database (2021-2024). Patient demographics, operative characteristics, extraction times, and healthcare utilization outcomes (length of stay [LOS], discharge disposition, 90-day readmission, 90-day complications, and 1-year reoperations) were analyzed using nonparametric and categorical statistical tests.
Results:
Baseline characteristics were similar across groups. Cup sizes removed and reimplanted were largely comparable between groups, indicating minimal differences in bone preservation. Time to cup removal was significantly shorter with the powered device, with 82% completed in ≤10 minutes and none exceeding 20 minutes, compared with the manual group where 58% required 5 to 10 minutes, 33% required 10 to 20 minutes, and 8% exceeded 20 minutes (p < 0.001). Healthcare utilization metrics, including LOS ≥3 days (50.0% vs. 56.4%, p = 1.000), nonhome discharge (25.0% vs. 18.2%, p = 0.572), 90-day readmission (21.9% vs. 7.6%, p = 0.054), 1-year reoperation (6.3% vs. 7.6%, p = 1.000), and 90-day complications (21.9% vs. 13.6%, p = 0.457), did not differ significantly.
Conclusion:
The use of the powered acetabular extraction system was associated with significantly reduced extraction times compared with a manual extraction device in R-THA. One-year reoperation rates were comparable, as were complication/readmission rates and replacement cup sizes. These findings highlight the efficiency benefits of powered explantation as well as its safety.
Level Of Evidence:
Level III (Retrospective comparative cohort study). See Instructions for Authors for a complete description of levels of evidence.
