Controlled perforation. A safe method of cement removal from the femoral canal.

Removal of cement from the femoral canal during total hip revision arthroplasty continues to be very challenging. The technique is described using multiple 9-mm perforations placed at least 5 cm apart on the anterior surface of the femoral shaft. The tip of the revision stem should be at least 5 cm distal to the most distal perforation. From January 1984 to December 1986, 219 cases of revision total hip arthroplasties were performed using this technique; the incidence of ipsilateral postoperative femoral fractures was nine out of 219. Eight of these fractures were at the tip or distal to the femoral prosthesis and were associated with trauma. One fracture occurred through a perforation site and had an associated fracture of the femoral component. This method appears to be a reliable and safe method of cement removal from the femoral canal.