How to Remove Cemented Femoral Stems?

2026-04-09

How to Remove Cemented Femoral Stems?

After implantation, significant loosening of cemented femoral stems might occur, even to the extent of being removed by hand. However, "loosening" doesn't always equate to easy extraction.

Let's summarize the methods of removing implants from the femur.

01 Monoblock Design

For implants with an integrated stem and head, specialized instruments with a slide hammer or holding platform can be used. These instruments help bypass the head and hook onto the neck of the implant.

02 Modern Design

For modern stem designs with modular head-neck configurations, standard extraction devices usually remove the head easily, but not the stem. These systems typically have specific tools designed for stem removal.

Typical designs include hooks inserted through small holes in the stem for threaded instruments or clamp-like instruments for irregular necks. Identifying the stem design type is essential for preparing the required instruments for extraction.

If there's no specific extraction tool, instruments with expanding bolts can secure the stem's neck and facilitate its removal after anchoring.

Removing early-design cemented stems usually presents fewer challenges. These designs tend to be smooth-surfaced, gradually tapering, and less irregular. Before attempting stem extraction, remove any bone overgrowth covering the stem, as these could obstruct removal. If the stem's proximal end is curved, remove the cement adhered to the implant's shoulder to prevent midshaft femoral fracture during extraction.

Extracting cemented stems with PMMA or porous coatings can be challenging. To remove a non-loose stem due to infection or poor positioning, the cement or porous coating must be removed before extraction.

Use a grinding drill with a fine, long bit to separate the proximal cement or porous layer from the stem.

Avoid using a bone chisel at this point, as it can cause a wedge effect and split the femur. Only use a bone chisel after safely removing the stem, when there's a cavity in the femur's center to accommodate the detached cement.

Use a cutting drill to cut and grind around the stem until the coating or porous surface is fully exposed.

Insert the cutting drill from the front to the back at a certain angle, removing the inner cement layer.

For access to the stem's inner side, use metal cutting tools or alloy drills to remove the neck. If the stem is made of high-strength alloy, this process can be time-consuming.

After removing the proximal cement, attempt to extract the stem.

If forcefully tapping the extraction tool doesn't remove the stem even after completely removing the proximal cement, consider performing an extended rotor osteotomy to reach a larger cement-stem bonding surface, or create a cortical window on the anterior-lateral femoral cortex. The window should be just proximal to the level of removed cement, not at the tip of the stem. Continue removing cement through the window until the stem can be extracted.

★ Steps for Removing Proximal and Distal Femoral Cement:

🛠 Instruments