Department of Orthopaedics, University of Szeged, Hungary.
Arch Orthop Trauma Surg. 2010 Jul;130(7):813-8. doi: 10.1007/s00402-010-1063-x. Epub 2010 Feb 18.
Removal of a cemented femoral stem during revision total hip arthroplasty is a technically demanding procedure that requires a multitude of surgical techniques and tools. To gain full access to the cement and the stem, distal fenestration or a transfemoral approach is often required. This paper presents a technique of retrograde removal of femoral stems and cement from the distal femur.
The authors present five clinical cases. In two cases the femoral component and the surrounding cement was removed using this technique. In the other three cases, due to femoral component fracture, the distal fragment of the femoral component with its cement mantle was removed using the same technique. In an experimental study, we simulated the above technique and compared it with a windowing technique on six, paired cadaveric femora (12 femurs in all).
In all of the clinical cases the stem and the cement were removed completely without any complications. The cadaveric experiments clearly showed that the biomechanical resistance of the femur against compression and torsion forces is greatly decreased by using a window to access the proximal femur, compared with the retrograde technique, which shows no significant change.
Retrograde component removal provides a simple, rapid, and less invasive technique for stem and cement extraction in elective revision hip arthroplasty.
在翻修全髋关节置换术中，取出骨水泥固定的股骨柄是一项技术要求很高的操作，需要多种手术技术和工具。为了充分接触骨水泥和股骨柄，通常需要进行远端开窗或经股骨入路。本文介绍了一种从股骨远端取出股骨柄和骨水泥的逆行技术。
作者介绍了 5 个临床病例。在 2 个病例中，使用该技术取出了股骨组件和周围的骨水泥。在另外 3 个病例中，由于股骨组件骨折，使用相同的技术取出了带骨水泥套的股骨组件的远端碎片。在一项实验研究中，我们模拟了上述技术，并将其与在 6 对尸体股骨（共 12 个股骨）上进行的开窗技术进行了比较。
所有临床病例均无并发症地完整取出了股骨柄和骨水泥。尸体实验清楚地表明，与逆行技术相比，使用窗口进入近端股骨会大大降低股骨对压缩和扭转力的生物力学阻力，而逆行技术则没有明显变化。
逆行组件移除为选择性翻修髋关节置换术中股骨柄和骨水泥的提取提供了一种简单、快速和微创的技术。
