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Removal of Well Fixed Cementless Femoral Implants William J. Maloney, MD Professor and Chair, Department of Orthopaedic Surgery Stanford University

Conflict Disclosures

Stryker (Mako) – Royalties Boards – Western Orthopaedic Association, American Association of Hip and Knee Surgeons, Knee Society, American Joint Replacement Registry

Indications For Removal Well Fixed Cementless Stem • Infection • Osteolysis • Leg length discrepancy • Dislocation • Monoblock stem Damaged head Instability

• Broken stem - distal ingrowth

Stem Removal

Equipment • High Speed Drill Midas Rex Anspach Stryker

• Burrs Pencil Tip Metal Cutting

• Trephines

Stem Removal

Pre-op Considerations • Location of porous coating Proximal, Extensive, Patch

• Fixation surface Ongrowth, Ingrowth

• Implant Material Cobalt chrome Titanium

Stem Removal

Pre-op Considerations Study the X-rays • Proximal lysis • Proximal stress shielding • Spot welds

Stem Removal

Proximal Coated Stems • Start from the top • If necessary - ETO • Osteotomy level Just distal to ingrowth surface

Stem Removal

Stem Removal

Stem Removal

Stem Removal

Stem Removal

Fully Coated Stems • Extended trochanteric osteotomy • Section stem at the cylindrical portion

Broken Stem

Stem Removal