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Two-Stage Revision Total Hip Arthroplasty

CASE STUDY A 67-year-old man underwent a primary, uncemented, left total hip arthroplasty (THA) 11 years earlier for osteoarthritis ( Fig. 76.1 ). His postoperative course was uneventful, and he was followed by his surgeon on a yearly basis. He presented to the surgeon’s office complaining of a 3-week history of increasing left hip pain, swelling, and discomfort with weight bearing and range of motion. There…

Single-Stage Revision Total Hip Arthroplasty

CASE STUDIES Case 1: Permanent Temporary Spacer A 76-year-old man presented to the emergency room with fever and a 2-week history of worsening left hip pain followed by an acute dislocation. The patient had undergone total hip arthroplasty (THA) 12 years earlier. The left hip functioned well until 1 year ago, at which time he began to experience recurrent dislocation caused by polyethylene wear. He had…

History and Diagnostic Testing

Introduction Since its popularization by Sir John Charnley in 1962 and subsequent globalization, total hip arthroplasty (THA) has become recognized as one of the most successful surgical procedures in all of medicine, providing lasting pain relief and functional restoration. Of the several complications associated with joint arthroplasty operations, none is more challenging than periprosthetic joint infection (PJI). PJI is by no means a new obstacle for…

Revision of Articular Bearing Complications

Revision of Metal-on-Metal Bearing Surfaces in Hip Arthroplasty Skylar Johnson, MD Oladapo M. Babatunde, MD Jonathan Lee, MD William B. Macaulay, MD CASE STUDY A 60-year-old woman, who had left primary metal-on-metal hip resurfacing 3.5 years earlier for severe osteoarthritis, presented with increasing left hip pain, clicking, and swelling over the preceding several months. Her postoperative course had been uncomplicated, and she had excellent pain relief for more than 3…

Revision Arthroplasty for Periprosthetic Femoral Fracture

Introduction Periprosthetic femoral fracture complicating hip arthroplasty is relatively common. The reported incidence is just below 1% after primary reconstruction and up to 4.2% after revision surgery. These cases present a challenge to the orthopedic surgeon because the fracture is often complicated by significant osteopenia, bone loss, and multiple medical comorbidities that make the patient intolerant of a physiologically taxing surgical procedure and prolonged postoperative weight-bearing…

Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty

CASE STUDY A 92-year-old woman sustained an injury to her left lower extremity after falling from a standing position. Her surgical history is significant for a left hybrid total hip arthroplasty with a cemented femoral stem that was performed 15 years earlier. Physical examination revealed shortening and deformity of the affected extremity with no neurovascular deficits. Injury radiographs were obtained ( Figs. 71.1 and 71.2 ).…

Management of Thigh Pain in Cementless Arthroplasty

CASE STUDY A 65-year-old man underwent a left cementless total hip arthroplasty for degenerative osteoarthritis using a large, cylindrical, cobalt–chrome stem. The postoperative course was uneventful, and the patient had a pain-free interval after the procedure. The patient presented 3 years later with a dull, isolated, aching pain in the anterolateral thigh. He had no history of recent trauma, systemic illness, or back symptoms. The discomfort…

Management of Wear and Osteolysis

CASE STUDY A 49-year-old man presented with left groin pain that began insidiously and had been getting progressively worse over the past few months. He had previously been pain free. Eleven years earlier, he had primary total hip arthroplasty to treat the effects of osteoarthritis caused by acetabular dysplasia. Physical examination confirmed a mild Trendelenburg lurch, a mildly antalgic gait related to his right lower extremity,…

Instability After Total Hip Arthroplasty

CASE STUDY A 78-year-old woman underwent right total hip arthroplasty using a posterolateral approach 4 years before she was referred to our center. During that time, she sustained two posterior hip dislocations that were treated successfully by closed reduction. She also reported sensations of the hip clicking, for which she had to “turn” it back into place. Infection was ruled out by negative serology results. Radiographs…

Conversion of Prior Surgery to Total Hip Arthroplasty

CASE STUDY A 50-year-old male presented with severe right hip pain, Trendelenberg gait, and limb length discrepancy. He had an open reduction with internal fixation for a childhood hip fracture. Radiographic evaluation demonstrated severe arthritic changes with proximal femoral deformity, retained hardware, and a limb length discrepancy ( Fig. 67.1 ). The patient elected to undergo total hip replacement. A cementless socket was utilized; while in…

Megaprosthesis of the Hip

CASE STUDY A 76-year-old man sought consultation for a painful revision left hip arthroplasty, limb length discrepancy, and difficulty with ambulation. He had undergone a hip arthrodesis in his mid-40s to address the disabling posttraumatic arthritis that developed after a motor vehicle collision that occurred when he was a young man. This arthrodesis was converted to a hemiarthroplasty and subsequently to a total hip arthroplasty (THA).…

Modular, Fluted, Tapered, Grit-Blasted Titanium Stems for Femoral Revision

CASE STUDY A 75-year-old woman presented with a loose cemented stem ( Fig. 65.1 , A ). Evaluation of the radiographs showed that despite appropriate overall bone quality, osteolysis had compromised the bone stock down to the isthmus. Confronted with this Paprosky type IIIB femoral deficiency, it was decided to revise the femur with a modular, fluted, tapered, grit-blasted titanium stem (Revitan, Zimmer, Warsaw, Ind.) (see…

Surgical Techniques: Extensively Porous-Coated, Cylindrical Stems

Chapter Preview Chapter Synopsis This chapter reviews the indications and techniques for successful implantation of an extensively porous-coated stem for management of the femoral component in revision hip arthroplasty. Important Points Preoperative templating, including on lateral radiographs, is used to determine whether a curved stem is required and to establish the level of an extended osteotomy. Extended trochanteric osteotomy should be used with little hesitation if…

Proximal Porous-Coated Modular Stems: Surgical Technique

CASE STUDY A 63-year old male patient presented with chief complaints of persistent thigh pain and restriction of function at 1 year following primary total hip arthroplasty (THA) performed for degenerative hip arthritis. A proximally porous coated tapered wedge stem was used during primary surgery. Continuous radiolucencies were seen in Gruen zones 1, 2, 6, and 7 on anteroposterior radiographs ( Fig. 62.1, A ) and…

Femoral Revision Arthroplasty With a Modular Cementless Prosthesis

CASE STUDIES Case 1 A 63-year-old man underwent primary total hip arthroplasty (THA) of the right hip for degenerative arthritis with a proximal, porous-coated, tapered-wedge stem. The patient complained of significant pain and progressive restriction of function at the 1-year follow-up assessment. Continuous radiolucencies were seen in Gruen zones 1, 2, 6, and 7 on anteroposterior radiographs and in zones 8 and 9 on the lateral…

Cemented Femoral Revision in Total Hip Arthroplasty

CASE STUDIES Case 1: Cemented Femoral Revision A 92-year-old woman underwent revision total hip arthroplasty for femoral loosening. Reconstruction used a porous-coated femoral component. Seven years later, she presented with increased thigh pain. Radiographs showed catastrophic failure (fracture) of her femoral component at the proximal third of the diaphyseal aspect of the stem, a loose proximal stem, and a well-fixed distal stem ( Fig. 60.1 ,…

Acetabular Reconstruction

Options for Acetabular Revision Derek R. Jenkins, MD Rafael J. Sierra, MD David G. Lewallen, MD CASE STUDY In 2000, a 72-year-old woman, who had a right, porous-coated anatomic prosthesis placed in 1986, presented to our institution with a limp and complaints about groin pain with weight bearing and activity. This disability had progressed slowly over the past year. She was able to walk with a cane and had…

Acetabular Reconstruction With a Jumbo Socket

CASE STUDY An 80-year-old man presented with a failed acetabular component 29 years after the index total hip arthroplasty (THA). The patient was found to be free of infection. Radiographs identified a well-fixed, uncemented stem and a combined segmental and cavitary acetabular bone deficiency. The socket had migrated 1 cm superomedially, but posterior column and superolateral coverage remained intact. He had no history of pelvic irradiation.…

Landmarks to Determine the Anatomic Hip Center of Rotation

CASE STUDY 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…