Removal of well-fixed cemented and cementless femoral stems raises technical challenges during revision arthroplasty. Devastating complications can result from their extraction, including intraoperative fracture and cortex perforation. The objective when extracting any femoral stem is to remove the stem and prepare the femur for implantation of a new prosthesis. Generally, an intramedullary approach is sufficient. Keys to success for removal of both cementless and cemented well-fixed femoral stems include having knowledge of the existing implant and patient biology preoperatively, having the correct tools available for extraction with back-up options intraoperatively, and having multiple techniques or tricks for removal. Surgeons must be able to convert to a transfemoral approach for more difficult extractions. New systems for intramedullary removal of femoral stems, such as the Watson extraction system, are gaining popularity as they reduce the need for more invasive approaches and decrease risk of complications.