Techniques for removal of the stem: transfemoral or intramedullary?

Since 1981 a total of 76 reimplantations of the prosthetic stem have been performed, substituting 52 cemented stems and 24 cementless ones. Only 7 patients (9%) required transcortical access, 3 of these stems (43%) were not osteointegrated, while of the 69 reimplantations performed by intramedullary approach, only 4% of the stems did not achieve skeletal stabilization. A total of 43% of the stems reimplanted using an intramedullary approach were short (12-13 cm). The advantages of intramedullary access may be summarized by saying that diaphyseal cortical bone is saved; in the use of short prosthetic models. The transcortical technique is limited to a minority of patients, particularly to cases where stems that show osteointegration and are cementless are removed.