FEATURES OF REMOVAL OF STABLE FEMORAL STEMS OF HIP ENDOPROSTHESES

Abstract

The increase in the number of primary arthroplasty procedures has led to an increase in revision arthroplasty for periprosthetic infection and fractures of hip stems. The problem of removing stable stems remains relevant, as the lack of a unified approach leads to an increase in the duration of operations, an increased risk of complications and worsening of treatment outcomes. Objective. To review the existing methods and find out the most optimal approaches to the removal of stable stems of hip arthroplasties of different types of fixation. Methods. A systematic literature review was conducted using the electronic databases PubMed, Scopus, Web of Science for the period 1986–2023. 28 publications were analyzed. The authors’ own clinical experience was used (171 revision interventions from 2013 to 2024). Results. The method of removal depends on the type of fixation and design of the endoprosthesis stem. The main methods are: use of special instruments, window osteotomy, extended proximal osteotomy, transfemoral osteotomy. The choice of method depends on the specific situation, starting with the least traumatic approach. Conclusions. Removal of stable stems requires an individual approach and careful planning. Cemented polished stems are usually easier to remove, but there may be difficulties with the removal of the cement mantle. Cementless stems with distal fixation often require more aggressive methods. The choice of method should be based on the principle of minimal trauma, taking into account the possibility of further revision arthroplasty. It is recommended to have several alternative surgical plans. The proposed methodology of intraoperative actions allows optimizing the decision-making process, which contributes to improving the results of revision hip arthroplasty.