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A Novel Antero-Medial Cortical Window Technique for Removal of Well-Fixed Fully Porous Stem in Revision Total Hip Arthroplasty

Hideto Harada, Hiroshi Fujita*, Tomoo Okumura, Tomohiro Tominaga and Ryuuichi Nishimura

Fully porous-coated cementless stem has the advantage of good initial metaphyseal to diaphysial fixation. However, it is very difficult to remove the stem when complications develop. Extraction of a stem may cause huge damage to the femur. A long stem may be required to ensure stability for subsequent femoral reconstruction. Here we present a case employing a novel technique of minimizing invasion to the femur when a wellfixed, extensively porous-coated cementless stem needs to be removed. A 58-year-old woman had a revision total hip arthroplasty for trunnionosis after the left total hip arthroplasty. In the operation we made two cortical windows to the femur. It enabled us to reach all circumferences of the stem. By this technique the stem could be easily removed and the femoral canal structure was preserved. The femur could then be reconstructed with a stem of normal length. The Anatomic Medullary Locking (AML) stem is a representative implant of a fully porous-coated cementless stem that brings out the problems of trunnionosis which leads to adverse reaction to metal debris and stem neck fracture. Revision total hip arthroplasty is on the increase because of these complications. It is considered that our technique is useful in such cases.