Background: Revision total hip arthroplasty (THA) presents several unique challenges, one of which is the removal of osseointegrated uncemented femoral stems. Traditional techniques, such as extended trochanteric osteotomy, are associated with complications and patient morbidity. Recently, the advent of osteotome systems designed to facilitate femoral stem extraction has improved the capacity for complete fixation disruption without the need for osteotomy. This study describes our experience with one such novel system in a large series of revision THAs. Methods: Patients undergoing femoral component revision during revision THA from December 2017 to July 2024 were identified from our institutional database. We included and analyzed patients undergoing revision for any indication so long as the revised femoral component was cementless and confirmed to be osseointegrated at the time of revision surgery. Extraction was attempted with the femoral-extraction osteotome system of interest in all cases. Results: Of the 92 included cases, 65% involved single-taper wedge stems; 16%, fit-and-fill style designs; and 9%, fully hydroxyapatite (HA)-coated stems. Using the osteotome system, femoral extraction was successful (no intraoperative fracture or requirement for osteotomy) in 73% of the cases. Osteotomy was required in 10% of the cases but was not required for extraction of any single-taper wedge stem. Of those with fit-and-fill or fully HA-coated stems, 57% required osteotomy or sustained an extraction-related fracture. Extraction-related intraoperative fractures occurred in 13% of the cases. Conclusions: In this large series of revision THAs, the use of a novel osteotome system designed for femoral component extraction led to successful extraction in 73% of the cases. The relatively low rate of osteotomy (10%) suggests that this technique is useful, but it also highlights limitations and the need for further innovation given the contemporary shift toward the use of collared, fully coated triple-tapered stems. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Nour et al. (Wed,) studied this question.