Cement Removal using Ultrasonic Tools in Revision THA

Description: Paul E. Di Cesare, MD Co-Director, Arthritis Service Director, Cartilage & Bone Research Center Hospital for Joint Diseases Orthopaedic Institute New York
Removal of well-fixed or loose, cemented (polymethylmethacrylate) total hip components presents many challenges to the orthopaedic surgeon. In cases of loose components with extensive bone-cement radiolucencies, extraction may not be too difficult because a well-defined soft tissue plane that has been biologically placed facilitates removal of hard cement from hard bone. In cases where well-fixed cemented components and cement need to be removed - due to infection, catastrophic polyethelene wear, revision implant mismatch, malposition with chronic dislocations, and distal cement plugs and mantles the surgeon, how ever, may face difficult challenges that may lead to increased operative time, blood loss, bone perforation, or fracture. Additionally, in cases with cemented porous implants or implants with pre-coating to bond the stem to the cement, removal of the components again may not be easy. In these situations, it is often difficult to determine the plane between hard bone and hard cement which predisposes to operative difficulties.