Kuntscher nail removal: Revision of a failed hip resurfacing above an incarcerated Kuntscher nail. A case report of a smart nail extraction technique through a custom-made instrumentation.

Removal of a retained and osseointegrated intramedullary femoral nail can represent a considerable problem, especially in the case of contemporary total hip arthroplasty or, even worse, in the case of revision hip arthroplasty. Usually, complex and invasive surgical techniques are required to remove incarcerated Kuntscher nails. We described a case of an incarcerated Kuntscher nail, inserted 39 years before, in a 75-year-old woman waiting for a revision total hip arthroplasty of a failed metal-on-metal hip resurfacing. A CT-based custom-made extra-long trephine reamer was designed and successfully used to easily extract the nail, leaving the proximal femur before a revision hip arthroplasty.