Goplen C Michael, Munro Jacob
Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Community Service Center, Royal Alexandra Hospital, Edmonton, Canada.
Ann Jt. 2024 May 22;9:24. doi: 10.21037/aoj-23-34. eCollection 2024.
Removing well-fixed uncemented components can be challenging. With thoughtful surgical planning, appropriate surgical instruments, and proper surgical techniques, most implants can be removed expeditiously with little bone loss and minimal impact on the subsequent reconstruction. Preoperative planning is one of the most essential steps to remove uncemented implants. Obtaining previous surgical records, although tedious, should always be attempted preoperatively to determine if specific instruments will be required and to help anticipate which steps may need special attention. These include the presence of ceramic or metal bearings and the presence of acetabular screws or stem collars. Without proper preparation and available tools, the removal of implants can negatively impact the subsequent reconstruction and patient outcomes. We will describe techniques and practical tips for removing uncemented stems from the top (intramedullary) or transfemoral using an extended trochanteric osteotomy. We will also describe techniques and tools to remove uncemented acetabular shells efficiently. Case examples will highlight these clinical situations where careful planning is necessary and potential problems that may be encountered with the recurring theme of preparing for the worst but hoping for the best. We have also included cases such as removing well-fixed cementless collared stems, broken stems, and fully coated stems.
取出牢固固定的非骨水泥型假体可能具有挑战性。通过周全的手术规划、合适的手术器械和恰当的手术技术，大多数植入物能够迅速取出，骨量损失小，对后续重建的影响也最小。术前规划是取出非骨水泥型植入物最重要的步骤之一。获取既往手术记录，尽管繁琐，但术前应始终尝试这样做，以确定是否需要特定器械，并有助于预判哪些步骤可能需要特别关注。这些包括陶瓷或金属轴承的存在以及髋臼螺钉或柄部颈圈的存在。如果没有适当的准备和可用工具，植入物的取出可能会对后续重建和患者预后产生负面影响。我们将描述使用大转子延长截骨术从顶部（髓内）或经股骨取出非骨水泥型柄的技术和实用技巧。我们还将描述有效取出非骨水泥型髋臼杯的技术和工具。病例示例将突出这些需要仔细规划的临床情况以及可能遇到的潜在问题，反复强调要做最坏的打算但抱最好的希望。我们还纳入了诸如取出牢固固定的无领非骨水泥型柄、折断的柄和全涂层柄等病例。
