Retrograde genocephalic removal of fractured or immovable femoral stems in revision hip surgery.

Revision arthroplasty for femoral stem breakage can be challenging. We report a new method for the removal of the distal stem segment performed in 6 cases between 2004 and 2008. After extracting the proximal part of the femoral component, the femoral canal was opened at the knee joint and a modified intramedullary nail was used to dislodge the distal stem under fluoroscopic control. In five cases the surgery was uneventful. In one case femoral perforation occurred due to the contour of the cement mantle at the tip of the stem. In the postoperative period all patients progessed well. Removal of a broken stem using our method has limited indications, and it is not recommended in septic cases or when the cement mantle at the tip of the stem has an oblique contour. It also requires opening of the knee joint, but the technique is simple, saves surgical time and in selected cases it does not weaken the femur.