Extraction of a Fractured, Well-Fixed Femoral Stem Using a Lateral Cortical Window Technique in Revision Hip...

Fractures of hip prostheses have been well established in medical literature. Various biomechanical studies have shown that the highest concentration of stress occurs over the lateral aspect of the middle third of the femoral stem. Complications at this focal point include stem subsidence, cortical breach, or perforation. The purpose of this report is to describe a modified technique using a lateral cortical window for the extraction of a fractured femoral stem of a hemiarthroplasty.

We present a case of a 61-year-old female who complained of pain in the right thigh and difficulty walking, climbing stairs, and sitting cross-legged for 1 year. She had undergone right hip hemiarthroplasty 14 years ago for a neck of femur fracture elsewhere. On radiographs, she was diagnosed with a fracture of an Austin-Moore type prosthesis distal to the lesser trochanter. A revision total hip replacement was performed. The broken stem was retrieved by making a lateral cortical window using a high-speed burr. Extraction was performed using retrograde impaction by creating craters over the exposed stem using a tungsten carbide drill, and reconstructed with a diaphyseal long stem with a dual mobility cup and head.

Immediate post-operative weight bearing was permitted. On X-rays, the cortical window showed good union, and with a Harris Hip score of 88, she was able to perform all her routine activities at 3 months. At 1 year after surgery, she is comfortable and asymptomatic.

Creating a lateral cortical window combined with retrograde impaction provides a reliable, bone-preserving method for the extraction of a fractured, well-anchored femoral stem in revision hip arthroplasty procedures.