Khan Shujaa T, Huffman Nickelas, Walsh Jonathan, Pasqualini Ignacio, Piuzzi Nicolas S, Deren Matthew E
Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):27. doi: 10.1007/s00402-024-05701-y.
As the number of primary total hip arthroplasty (THA) procedures continues to increase, so too does the demand for revision surgery, with a 43-70% rise in revision THA anticipated by 2030. Femoral stem extraction in revision THA is particularly challenging and may lead to complications like femoral bone loss or fractures. However, increasing catalogue of femoral stems available for primary and revision THA has led technological advances in extraction devices to potentially overcome these limitations. This review aims to discuss the identification of femoral implants and the various femoral stem extraction devices currently available.
A scoping review of current literature was conducted to explore currently available femoral extraction devices. The devices not available in literature but used in clinical practice have also been included. This review focused on the technical components, advantages, and limitations of different femoral extraction tools, including osteotomes, reciprocating saws, high-speed burrs, trephines, and extraction systems like the Watson Extraction System, Exodus Revision Hip System, Shukla Hip Universal Stem Extraction System, and DePuy Synthes Extractors.
Identifying femoral implants is a critical step in preoperative planning to allow for appropriate equipment to be available during revision surgery. The present review highlights that no single extraction device is universally applicable. Tools like flexible osteotomes, burrs, and trephines offer versatility but may risk bone damage. Advanced systems like the Watson Extraction System and Shukla Hip Universal Stem Extraction System provide more precise extraction, reducing the likelihood of cortical perforations and decreasing operative time.
Efficient femoral stem extraction in rTHA is essential for managing complications and preserving bone stock. While traditional tools remain valuable, the development of specialized extraction systems offers improved precision and efficiency. Preoperative planning, including accurate implant identification, and the selection of appropriate extraction devices are crucial for successful outcomes in revision hip arthroplasty.
随着初次全髋关节置换术（THA）手术数量持续增加，翻修手术的需求也在上升，预计到2030年翻修THA将增加43% - 70%。翻修THA中的股骨柄取出尤其具有挑战性，可能会导致诸如股骨骨质流失或骨折等并发症。然而，用于初次和翻修THA的股骨柄种类不断增加，促使取出装置在技术上取得进步，有可能克服这些局限性。本综述旨在讨论股骨植入物的识别以及目前可用的各种股骨柄取出装置。
对当前文献进行了范围综述，以探索现有的股骨取出装置。文献中未提及但在临床实践中使用的装置也被纳入。本综述重点关注不同股骨取出工具的技术组件、优点和局限性，包括骨凿、往复锯、高速磨钻、环锯，以及诸如沃森取出系统、出埃及记翻修髋关节系统、舒克拉髋关节通用柄取出系统和德普伊辛迪斯取出器等取出系统。
识别股骨植入物是术前规划中的关键步骤，以便在翻修手术期间能够使用合适的设备。本综述强调没有单一的取出装置适用于所有情况。像柔性骨凿、磨钻和环锯等工具具有通用性，但可能有损伤骨质的风险。像沃森取出系统和舒克拉髋关节通用柄取出系统等先进系统提供更精确的取出，降低皮质穿孔的可能性并减少手术时间。
在翻修THA中高效取出股骨柄对于处理并发症和保留骨量至关重要。虽然传统工具仍然很有价值，但专门取出系统的发展提高了精度和效率。术前规划，包括准确识别植入物以及选择合适的取出装置，对于翻修髋关节置换术的成功结果至关重要。
