Landmarks to Determine the Anatomic Hip Center of Rotation

A 39-year-old West African man underwent his first total hip arthroplasty 13 years before presentation. His hospitalization was complicated by prolonged postoperative drainage and persistent pain. He presented for treatment with an 8-year history of hip pain with ambulation and night sweats. On physical examination, the patient was afebrile, had a shortened extremity, walked with a profound limp, and had groin pain with any passive rotation of the left hip. Radiographs of the pelvis and hip revealed grossly loose cemented components ( Fig. 57.1 ). Serology demonstrated a normal white blood cell count but an elevated C-reactive protein level and erythrocyte sedimentation rate. Aspirate cultures grew Staphylococcus aureus .

The patient was taken to surgery, where he underwent removal of his implants, followed by a radical soft tissue débridement and primary revision ( Fig. 57.2 ). The patient was treated with 6 weeks of intravenous antibiotics. His wounds healed uneventfully, and he remains pain and limp free 5 years after revision.