A minimally invasive technique to remove broken cemented stems and its reconstruction with cement-in-cement

Introduction: Historically the removal of fractured stems was associated with complex revision and loss of bone stock. This study describes a minimally invasive procedure for extraction of the distal part of a broken cemented stem that does not compromise the bone stock and results with the cement-in-cement reconstruction technique. Materials and method: 7 patients with an average age of 74 years who underwent total hip replacement (THR) revision for fracture of femoral stems were included. The average follow-up was 8.7 years. For the removal of the distal fragment of the broken stem, a set of instruments have been manufactured using a coupling through the wrought of a thread over the fractured face of the stem. 6 cases were reconstructed using a cement-in-cement technique. In 1 case an extended trochanteric osteotomy was required. Results: There were no complications associated with the surgical technique. Early rehabilitation and standing were achieved in all patients at 48 hours postoperatively. No patient required a blood transfusion. No clinical or radiological loosening was detected at final follow-up. Conclusions: Different methods have been described for the extraction of distal fragments of a broken femoral stem. The majority include the use of femoral osteotomies, bone windows and knee arthrotomies. These techniques are associated with bone loss and bleeding. The advantages of the method described are, its low complexity, low-cost, accelerated functional recovery and the preservation of bone stock with the possibility of performing cement-in-cement reconstruction techniques.