Posted: Feb 6 2023 #(C102136) Anterior Hip Foundation 2023 Innovation Symposium

Painful Total Hip Arthroplasty in 81F

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HPI

An 81-year-old female presents after 2 months of increased pain and right leg shortening. Right THA 13 years ago via posterior approach. Cup revision 7 years ago for aseptic loosening via posterior approach. No history of postoperative complications with either surgery.

PMH

HTN

Right leg short 3 cm, incision healed, no swelling or redness, restricted ROM. ESR/CRP- normal.

Poll

1 of 13

In addition to AP and LAT radiographs of the pelvis, would you obtain any further imaging to guide your treatment?

1 No - Current radiographs are sufficient

2 Yes - additional x-rays (i.e Judet views, aXR)

3 Yes - CT pelvis (CT)

4 Yes - MRI pelvis (MRI)

5 Yes - aXR + CT

6 Yes - aXR + MRI

7 Yes - CT + MRI

8 Yes - aXR + CT + MRI

9 Outside my area of expertise - best if I don't vote e

Other

Submit

P: 161716

Would you use a classification system to guide management?

1 No - a classification system would not help me

2 Yes - AAOS

3 Yes - Paprosky

4 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161718

If you choose the Paprosky classification, how would you classify this acetabular defect?

1 I would not choose Paprosky classification

2 Paprosky Type I

3 Paprosky Type IIA

4 Paprosky Type IIB

5 Paprosky Type IIC

6 Paprosky Type IIIA

7 Paprosky Type IIIB

8 Outside my area of expertise - best if I don't vote e

Other

Submit

P: 161719

If you choose Operative management, what would you do?

1 I would not choose Operative management

2 Resection arthroplasty (e.g. Girdlestone procedure) only

3 Open reduction and internal fixation (ORIF)

4 Revision arthroplasty only

5 Revision arthroplasty + ORIF

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161722

If you choose Operative management with Revision arthroplasty, what approach would you use?

1 I would not choose Operative management

2 Direct Anterior (includes Extended Direct Anterior)

3 Anterolateral

4 Lateral (Direct Lateral)

5 Posterolateral (Posterior)

6 Other

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161723

If you choose Revision arthroplasty, which components would you plan on revising?

1 I would not choose Revision arthroplasty only

2 Acetabulum only

3 Femur only

4 Acetabulum and Femur

5 Outside my area of expertise - best if I don't vote e

Other

Submit

P: 161724

If you choose Revision arthroplasty of the acetabular component, what reconstructive technique would you utilize?

1 I would not choose Revision Arthroplasty of the acetabular component only

2 Large Hemispherical Cup with Screws +/- Augments

3 Cup with Segmental Allograft

4 Cage

5 Cup + Cage +/- Augments

6 Distraction Techniques with Augments

7 Custom Triflange

8 Outside my area of expertise - best if I don't vote e

Other

Submit

P: 161725

If you choose Revision Arthroplasty of the femoral component, how would you revise it?

1 I would not choose Revision arthroplasty

2 I would Not revise the femur

3 Revise to Cemented stem

4 Revise to Monolithic stem

5 Revise to Modular stem

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161726

If you choose Revision arthroplasty, what is your choice for the new bearing surface and level of constraint?

1 I would not choose Revision arthroplasty

2 Large metal head on poly

3 Large ceramic head on poly

4 Dual mobility

5 Constrained liner

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161727

If you choose Operative management and attained the construct shown, how would you manage immediate post-operative weight-bearing?

1 I would not choose Operative management

2 Non-weight bearing (NWB)

3 Touch-down weight bearing (TDWB)

4 Partial weight bearing (PWB, < 25%)

5 Weight bearing as tolerated (WBAT)

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161729

If you choose Operative management and attained the construct shown below, what chemical anticoagulation would you use postoperatively?

1 I would not choose Operative management

2 None

3 Aspirin (any dose)

4 Low molecular weight heparin (ie. Lovenox)

5 Direct factor Xa inhibitors (ie. Rivaroxaban, Apixaban, Fondaparinux, etc.)

6 Warfarin (ie. Coumadin)

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 161728

In addition to AP and LAT radiographs of the pelvis, would you obtain any further imaging to guide your treatment?

Yes - CT pelvis (CT)

Would you use a classification system to guide management?

Yes - Paprosky

If you choose the Paprosky classification, how would you classify this acetabular defect?

Paprosky Type IIIB

If you choose Operative management, would you assess for infection intraoperatively?

No - preoperative workup is sufficient

If you choose Operative management, what would you do?

Revision arthroplasty only

If you choose Operative management with Revision arthroplasty, what approach would you use?

Direct Anterior (includes Extended Direct Anterior)

If you choose Revision arthroplasty, which components would you plan on revising?

Acetabulum only

If you choose Revision arthroplasty of the acetabular component, what reconstructive technique would you utilize?

Large Hemispherical Cup with Screws +/- Augments

If you choose Revision Arthroplasty of the femoral component, how would you revise it?

I would Not revise the femur

If you choose Revision arthroplasty, what is your choice for the new bearing surface and level of constraint?

Dual mobility

If you choose Operative management and attained the construct shown, how would you manage immediate post-operative weight-bearing?

Touch-down weight bearing (TDWB)

If you choose Operative management and attained the construct shown below, what chemical anticoagulation would you use postoperatively?

Aspirin (any dose)

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