CASE STUDIES Case 1 A 79-year-old woman presented after a primary total hip arthroplasty (THA) for a second opinion. During the primary THA, there was a fracture of her acetabulum. During surgery, the anterior and posterior columns were found to be intact. She was treated with an acetabular component with screw fixation and medial bone grafting ( Fig. 56.1 ). Case 2 A 51-year-old man presented…
CASE STUDIES Case 1 A 54-year-old male had a failed attempt of an acetabular reconstruction with a bilobed component ( Fig.55.1 ). He was found to have a large posterior column defect and a pelvic dissociation. A cage reconstruction with bone grafting was used to bridge the discontinuity. Case 2 A 90-year-old woman presented with a failed acetabular component and superior segmental bone loss ( Fig.…
Chapter Preview Chapter Synopsis This chapter describes the appropriate treatment of cavitary defects. Important Points Cavitary defects are contained defects. The defects may be successfully treated with a hemispherical or elliptical acetabular component and supplemental bone grafting. Clinical/Surgical Pearls Structural integrity should be carefully assessed to ensure that there is no violation of the posterior column or a pelvic discontinuity. The location of the true hip…
CASE STUDY Case 1: Extended Trochanteric Osteotomy A 67-year-old woman presented with a 4-month history of right thigh pain with weight bearing 10 years after a right hybrid total hip arthroplasty (THA) (see Fig. 53.1 ). She previously had no pain or limitation with weight bearing. After considering the results of laboratory tests and radiographic studies, femoral component revision was recommended. Extended Trochanteric Osteotomy Introduction Because…
CASE STUDY A 50-year-old man with no significant medical history underwent primary left total hip arthroplasty (THA) 9 years earlier. He returned to the medical office with a new limp and pain in his left hip that had increased during the past month. His postoperative course was previously uncomplicated, and he did not report any constitutional symptoms or recent illnesses. Radiographs of the hip demonstrated a…
CASE STUDY A 69-year-old woman underwent primary total hip arthroplasty (THA) using a direct anterior approach without apparent complications ( Fig. 51.1 ). She presented to a local emergency department complaining of increased right hip pain and an inability to bear weight on the affected limb. She denied any preceding trauma or injury. Radiographs revealed significant subsidence of the stem without an obvious fracture ( Fig.…
Chapter Preview Chapter Synopsis The direct lateral or transgluteal approach for total hip arthroplasty (THA) is used by clinicians worldwide. Clinical outcomes and potential complications are similar to those for other surgical approaches to the hip joint. Important Points Primary and straightforward revision THAs can be accomplished with a direct lateral approach. Clinical/Surgical Pearls Surgery may be performed with the patient in the supine or lateral…
CASE STUDY A 42-year-old man presented with bilateral hip pain 1 year after undergoing staged, bilateral total hip arthroplasties (THAs). The patient had his right hip replaced first, with good early results, followed 6 weeks later by a left THA. Wound healing on the left was delayed, and he underwent superficial irrigation and débridement without complication. On presentation, the patient reported a 3-month history of squeaking,…
CASE STUDY An 81-year-old woman presented with pain in the right hip and thigh that was associated with progressive difficulty in ambulating and putting weight on the right leg. She had undergone a hybrid total hip arthroplasty (THA) approximately 13 years earlier. Radiographs revealed loosening of the cemented stem with subsidence, cement mantle fracture, varus collapse, osteolysis in all Gruen zones, and Paprosky type IIIB bone…
Chapter Preview Chapter Synopsis In this chapter, we review the indications and techniques for successful removal of the femoral components in revision total hip arthroplasty. Important Points Before femoral extraction, a full workup is performed to assess component loosening. Cortical bone stock of the femur is evaluated preoperatively. An extended trochanteric osteotomy (ETO) is used to minimize bone loss and prevent perioperative fracture. Clinical/Surgical Pearls The…
Chapter Preview Chapter Synopsis This chapter reviews classification systems for femoral bone loss in total hip arthroplasty. Important Points Preoperative radiographic evaluation of bone loss helps to evaluate intraoperative findings. Extended trochanteric osteotomy should be used with little hesitation if needed to aid in implant extraction and safe, accurate femoral preparation. Clinical/Surgical Pearls Appropriate treatment of femoral bone loss can be determined by intraoperative classification. Needed…
Introduction Removing a solidly fixed, cemented or cementless acetabular component with minimal bone loss while avoiding further structural damage to the pelvis can be technically challenging as well as time consuming. The success of total hip arthroplasty (THA) depends in large part on the quality, volume, and location of host bone after implant removal. If revision surgery is not done meticulously, significant damage can occur to…
Algorithm Treatment algorithm for acetabular revision proposed by Paprosky. Introduction Numerous steps and technical issues are involved in performing an acetabular revision. Success depends on intimate contact between the implant and the remaining host bone and on creating a stable mechanical construct that minimizes micromotion, promotes bone ingrowth, and distributes the physiologic forces evenly to the surrounding acetabulum or pelvis. As in primary total hip arthroplasty…
Introduction The demand for primary total hip arthroplasty (THA) is expected to increase during the next few decades, ensuring a concomitant increase in revision THAs. Revisions are projected to increase from 40,800 cases in 2005 to 96,700 cases in 2030. Revision of the acetabular component accounts for more than 50% of cases, and common reasons for these procedures include instability, infection, polyethylene wear, and aseptic loosening.…
CASE STUDIES Case 1 A 39-year-old man had a right total hip arthroplasty (THA) in 1996 at the age of 26 for degenerative changes of the hip caused by osteomyelitis he had as a child. Pain developed over the course of a week and was localized to the right buttock. He had no history of trauma. There were no constitutional symptoms to suggest an underlying infection.…
CASE STUDY A 50-year-old man underwent left total hip replacement to treat osteoarthritis. Because of his age and activity level, a large resurfacing socket was used to maximize stability and minimize wear ( Fig. 41.1 , A ). The patient presented 3 years later with continued discomfort localized in his hip. Radiographs demonstrated socket migration with evidence of a complete radiolucent line around the socket. The…
Introduction Magnetic resonance imaging (MRI) has proved extremely useful for evaluating the painful hip prosthesis. MRI with excellent soft tissue contrast offers significant advantages over computed tomography and plain radiography for evaluating periprosthetic soft tissues and adjacent osseous structures. MRI is more sensitive and specific for the detection of periprosthetic osteolysis, aseptic loosening, and intraarticular burden of particle disease without the harmful effects of ionizing radiation.…
CASE STUDY A 48-year-old man presented with increasing left groin pain that was exacerbated by weight-bearing activities. He underwent primary, cementless, left total hip arthroplasty 15 years earlier for posttraumatic arthrosis. He reported that his limb has been getting shorter. Physical examination revealed an antalgic gait related to his left lower extremity, a moderate Trendelenburg lurch, a stiff left hip, a shortened left lower extremity, and…
CASE STUDY A 45-year-old man presented with bilateral hip pain (greater on the right side than the left) that had been worsening over the past 5 years. The pain was located in the groin and was exacerbated by walking. His hip motion had deteriorated over time. Radiographs demonstrated severe osteoarthritis, and total hip arthroplasty (THA) was recommended ( Fig. 38.1 ). THA was performed by a…
CASE STUDY A 65-year-old man presented with complaints of wound drainage, pain, and infection of his left knee replacement lasting 2 years. He had undergone a primary knee replacement 3 years before presentation. One year after knee replacement, he underwent a polyethylene exchange because of instability. This was complicated by an acute postoperative deep periprosthetic infection. He was treated with débridement and 6 weeks of antibiotics,…