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Hip Osteoarthritis
Posted: May 24 2023 #(C102192)
A

Hip Pain with Prior Cephalomedullary Nail in 82F

HPI

This 82-year-old retired accountant presents with left hip pain and stiffness 2 years following cephalomedullary nail stabilization of a left intertrochanteric hip fracture. The pain is severe enough that it limits many of her daily activities and she walks with a significant limp and is cane dependent. She attempted conservative treatments including physical therapy to try increase her hip motion, and nonsteroidal anti-inflammatories, but neither of these led to significant improvement in her symptoms. A metal suppression MRI was performed (not shown) that showed osteonecrosis that encompassed the vast majority of her femoral head with evidence of femoral head collapse.

PMH

Unremarkable

PE

On physical exam she has a 15 degree hip flexion contracture and 10 degree external rotation contracture in that left leg. Absolute external rotation is around 20 degrees. She has percutaneous small incisions located relatively posteriorly that are well healed with no erythema or other signs of infection. She has normal femoral and sciatic nerve root function and normal dorsalis and posterior tibial pulses. She had no significant hip abductor weakness and no Trendelenburg sign.

Poll
1 of 11
1. In addition to AP and LAT radiographs of the hip, what additional imaging would you obtain to guide management?
None - current radiographs are sufficient
47%
267/568
Additional radiographic views (aXR)
2%
14/568
CT scan of the hip (CT)
20%
117/568
MRI scan of the hip (MRI)
18%
107/568
CT + aXR
1%
11/568
MRI + aXR
0%
5/568
MRI + CT
6%
36/568
MRI + CT + aXR
0%
1/568
Outside my area of expertise - best if I do not vote
1%
10/568
2. If you choose Arthroplasty, what procedure would you perform?
I would not choose Operative management
0%
3/531
Interpositional arthroplasty
0%
0/531
Hip Hemiarthroplasty
12%
69/531
Hip resurfacing
0%
1/531
Total Hip Arthroplasty (THA)
84%
450/531
Outside my area of expertise - best if I don't vote
1%
8/531
3. If you choose Total hip arthroplasty (THA), would you extract the Proximal Femoral Implant (PFI) in Single procedure or Staged procedure?
I would not choose THA
1%
10/522
Single - Remove it during the same surgery as the THA
87%
458/522
Staged - Remove in separate operation - readmit at later date for THA
7%
41/522
Staged - Remove in separate operation - same hospitalization different days
1%
6/522
Outside my area of expertise - best if I don't vote
1%
7/522
4. If you choose Staged Proximal Femoral Implant (PFI) Extraction and THA on different hospital admissions, how long would you wait between the implant extraction and THA?
I would not choose Staged Proximal Femoral Implant (PFI) Extraction and THA on different hospital admissions
66%
341/512
~ 1 weeks
0%
5/512
~ 2 weeks
3%
17/512
~ 3 weeks
2%
14/512
~ 4 weeks
8%
41/512
~ 2 months
6%
34/512
~ 3 months
7%
39/512
4 months or greater
0%
5/512
Outside my area of expertise - best if I don't vote
3%
16/512
5. If you choose Single-procedure Proximal Femoral Implant (PFI) Extraction and THA, what approach would you use?
I would not choose Single-procedure PFI Extraction and THA
2%
15/510
Anterior (Smith-Petersen)
7%
40/510
Anterolateral (Watson-Jones)
14%
74/510
Lateral (Hardinge)
25%
129/510
Posterior (Southern-Moore)
46%
239/510
Outside my area of expertise - best if I don't vote
2%
13/510
6. If you choose Single-procedure Proximal Femoral Implant (PFI) Extraction and THA, would you cement your components?
I would not choose Single-procedure PFI Extraction and THA
2%
13/499
No - I would Not cement either component
40%
201/499
Yes - Cement Femur Alone
38%
190/499
Yes - Cement Acetabulum Alone
1%
8/499
Yes - Cement Femur & Acetabulum
15%
77/499
Outside my area of expertise - best if I don't vote
2%
10/499
7. If you choose Single-procedure Proximal Femoral Implant (PFI) Extraction and THA with press-fit fixation of the femur, what type would you use?
I would not choose Single-procedure PFI Extraction and THA with press-fit fixation of the femur
24%
119/495
Metaphyseal Press-fit fixation
33%
168/495
Diaphyseal Press-fit fixation
37%
184/495
Outside my area of expertise - best if I don't vote
4%
24/495
8. If you choose Total Hip Arthroplasty (THA) with a press-fit acetabular cup and obtained a good bite, would you add acetabular screw(s)?
I would not choose THA
5%
29/492
No - not necessary
46%
227/492
Yes - 1 screw
15%
75/492
Yes - 2 screws
27%
133/492
Yes - > 2 screws
2%
12/492
Outside my area of expertise - best if I don't vote
3%
16/492
9. If you choose Total hip arthroplasty (THA), what bearing articulation would you use?
I would not choose THA
0%
4/490
Metal-on-metal
0%
1/490
Metal-on-polyethylene
42%
208/490
Ceramic-on-ceramic
2%
13/490
Ceramic-on-polyethylene
29%
144/490
Dual mobility with a metal inner head
12%
60/490
Dual mobility with a ceramic inner head
9%
46/490
Outside my area of expertise - best if I don't vote
2%
14/490
10. If you choose Single-procedure Proximal Femoral Implant (PFI) Extraction and THA, what technology would you use to optimize the position of the components?
I would not choose Single-procedure PFI Extraction and THA
2%
11/489
None - Direct Visualization Alone
62%
305/489
Fluoroscopy (Fluoro) Alone
23%
115/489
Computer Assisted Navigation Alone (Nav)
2%
13/489
Robot-Assisted Navigation (Robot)
3%
18/489
Fluoro + Nav
1%
5/489
Fluoro + Robot
1%
5/489
Other Technology
0%
3/489
Outside my area of expertise - best if I don't vote
2%
14/489
11. If you choose Single-procedure Proximal Femoral Implant (PFI) Extraction and THA with Computer Assisted Navigation Alone (Nav) or Robotics, what type would you use?
I would not choose Single-procedure Proximal Femoral Implant (PFI) Extraction and THA with Computer Assisted Navigation Alone (Nav) or Robotics
38%
185/482
I would not use Computer Assisted Navigation Alone (Nav) or Robotics
34%
168/482
Imageless Computer Assisted Navigation (e.g., Naviswiss)
2%
10/482
Imageless Robotics (e.g., Rosa)
1%
8/482
Preop CT-Based Robotics (e.g., Mako)
8%
40/482
Fluoro-based Computer Assisted Navigation
3%
16/482
Other
0%
2/482
Outside of my area of expertise - best if I don't vote
10%
53/482
PROCEDURE #1 DOP: 9/25/2017

Cephallomedullary Rod Removal and Direct Anterior THA

Intra-procedure P1
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OUTCOMES
4 years after
Post-procedure P1
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