Use of a Trephine to Extract a Fractured Corail Femoral Stem During Revision Total Hip Arthroplasty: Tips From Our Case Report

Despite the significant advancements in the field of total hip arthroplasty (THA) and prosthesis designs, fracture of the modular femoral stem after THA can occur rarely and needs attention. Orthopaedic surgeons face a daunting task when it comes to the removal of a broken stem. The use of a trephine reamer has been evaluated for extracting the distal femoral stem, and this case report tries to address some key tips for the same. A 67-year-old obese male, without any major medical comorbidities, presented to the Royal Lancaster Infirmary orthopaedic outpatient department with a complaint of acute-on-chronic right anterior thigh pain that worsened over a few weeks. He had a history of bilateral staged uncemented THA done around 12 years ago. The plain radiological images confirmed the presence of a fracture of the Corail femoral stem. A posterior approach was used to dislocate the hip and the distal broken part of the stem was removed using trephines. Reamers were used and care was taken to prevent thermal necrosis by using intermittent saline lavage. After the removal of the fractured femoral stem, a cemented femoral revision THA was performed, which was uneventful. The patient walked without any aid or thigh pain postoperatively during his last follow-up. Using trephines to remove broken femoral stems is an effective and safe method. Intraoperative measures can help in avoiding heat necrosis while using a trephine reamer for extracting the fractured femoral stem. Regular follow-up and counselling are important after THA, to avoid a delayed diagnosis of non-traumatic femoral stem fractures.