Femoral stem extraction without osteotomy: Step-by-step sugical technique

Cemented Stem Extraction

For cemented implants, stem extraction is often straightforward, while complete cement removal represents the real challenge. The technique combines a range of specialised extraction tools, including flag chisels, flexible interchangeable-blade chisel, drilling, reaming and retrograde hooks, to progressively remove the cement mantle and residual fragments. Careful verification of the reaming trajectory is essential to avoid false passages and ensure safe femoral stem removal.

Uncemented Stem Extraction

For well-fixed uncemented implants, the objective is to disrupt all bone-implant fixation zones while preserving femoral bone stock. Reciprocant saw and interchangeable-blade chisels are used around the metaphysis, diaphysis and calcar, while K-wires may facilitate access to distal fixation when conventional extraction maneuvers fail. This stepwise approach helps surgeons perform femoral stem extraction safely while minimising the risk of fracture.

Technical pearls

• Optimise leg positioning before extraction.
• Address all fixation zones, including the calcar.
• Use dedicated extraction instruments according to the fixation pattern.
• Confirm reaming direction throughout cement removal.
• Establish a time threshold (20-30 minutes) for stem extraction without ETO and change your strategy when necessary.