Abstract
Introduction: Cement removal in revision total hip arthroplast;y can be technically challenging. Traditional methods can be associated with femoral fracture or uncontrolled cortical perforation and bone loss. A new technique has been developed tha.t permits segmental extraction of bone cement from the femoral canal. Fresh cement is introduced into the old cement mantle and a threaded rod is placed into the wet cement and held in place while the cement hardens. The thread-forming rod is then removed leaving a threaded channel in the cement. Extraction rods are then screwed 1.5 to 2.5 cm into the threaded channel. A slap hammer, which attaches to the opposite end of the extraction rod, is used to remove 1.5- to 2.5-cm segments of cement. The old cement – cancellous bone interface fails before the new-old cement interface and the old/new cement is removed in segments. This allows minimal removal of cancellous bone.
Patients and Methods: Patients who had contra-indications to segmental cement removal such a discontinuous cement mantle were excluded. Twenty-five consecutive cases of revision arthroplasty were entered into the study. The indications were for aseptic loosening in twenty-three cases and deep infection in two cases.
Results: In twenty-two cases the cement was removed completely. In five cases the cement was removed en-bloc in one single extraction rather then in segments. In two cases there was failure of the new cement to bond to the original cement and alternative methods were used. In a further case the cement was removed using a combination of segmental and conventional techniques. There were no cases of cortical perforations or perforaltions in this series. We have found it to be a reliable and safe method of cement removal. The cost of the system is offset by reduced operative time and blood loss.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at the Irish Orthopaedic Association, Secretariat, c/o Cappagh Orthopaedic Hospital, Finglas, Dublin
