Posted: Mar 20 2020 #(C101399)

Hip Arthrodesis in 64F

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HPI

Hip surgery in South America 25 years ago for an unclear indication. No medical records available. Now presents with progressive back pain, right hip pain, and significant leg length discrepancy.

PMH

HTN, HLD, DM2, anxiety/depression

BMI 31. Severe antalgic limp. Well-healed anterolateral hip incision. Hip is fused in 20 degrees of flexion, 20 degrees of external rotation, and 20 degrees of abduction. Painful with any attempted hip motion. Right leg is 4 cm shorter than the left leg. Neurovascularly intact distally.

Poll

1 of 7

What additional imaging studies would you obtain?

1 Judet view pelvis x-rays

2 CT scan of pelvis/hip

3 MRI scan of pelvis/hip, with metal artifact reduction sequencing

4 3-phase bone scan

5 No additional imaging studies needed

Other

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P: 109852

What additional laboratory studies would you obtain?

1 Serum Co, Cr, and Ti metal ion levels

2 Serum ESR and CRP

3 Serum IL-6

4 No additional laboratory studies needed

Other

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P: 109853

What would you next recommend?

1 Conservative management/symptomatic care

2 Removal of hardware

3 Revision hip arthrodesis with autograft

4 Conversion to total hip arthroplasty (THA)

Other

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P: 109854

If converting to THA, would you stage the procedure?

1 Yes

2 No

Other

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P: 109855

If converting to THA, what surgical approach would you employ?

1 Ilioinguinal

2 Iliofemoral

3 Direct lateral

4 Anterolateral

5 Posterolateral

Other

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P: 109878

If converting to THA, how would you address acetabular reconstruction?

1 High hip center with constrained liner

2 High hip center with polyethylene or dual mobility liner

3 Anatomic hip center with constrained liner

4 Anatomic hip center with polyethylene or dual mobility liner

Other

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P: 109856

If converting to THA, how would you address femoral reconstruction?

1 Cemented stem

2 Metaphyseal tapered pressfit stem

3 Extensively porous coated cylindrical pressfit stem

4 Modular, tapered, fluted pressfit stem

5 Custom pressfit stem

Other

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P: 109857

Intra-procedure P1

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