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THA Revision
Posted: Apr 3 2022 #(C102028)
A

Painful Total Hip Arthroplasty in 58M

HPI

A 58-year-old male presents with left hip pain that has been progressive over the last 6 months. He initially had a hemi resurfacing for AVN at the age of 16. This was subsequently converted to a THA in 1987. Two years later he underwent acetabular revision for aseptic loosening, which served him well for 10 years. In 1999, he underwent a 2-stage reconstruction for a gram negative infection and has been doing well up until the last 6 months. He denies any fevers, chills or incisional pain.

PMH

PMH: None PSH: as above Social Hx: nonsmoker, lives with wife

PE

General: BMI 20 Focused exam of the LLE demonstrates a 3 cm leg length discrepancy. Active range of motion is 80 degrees flexion, 10 degrees of IR/ER. There is pain with Stinchfield testing. Prior incision is well healed without evidence of erythema or drainage. He is neurovascularly intact distally. Labs: ESR 2, CRP <1

Poll
1 of 10
1. In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
No - Current radiographs are sufficient
12%
86/671
Yes - additional x-rays (i.e Judet views, aXR)
3%
23/671
Yes - CT pelvis (CT)
63%
423/671
Yes - MRI pelvis (MRI)
2%
16/671
Yes - aXR + CT
8%
57/671
Yes - aXR + MRI
0%
4/671
Yes - CT + MRI
3%
26/671
Yes - aXR + CT + MRI
2%
15/671
Outside my area of expertise - best if I don't vote e
3%
21/671
2. Would you use a classification system to guide management?
No - a classification system would not help me
34%
225/647
Yes - AAOS
5%
33/647
Yes - Paprosky
54%
352/647
Outside my area of expertise - best if I don't vote
5%
37/647
3. If you choose the Paprosky classification, would you classify this acetabular defect?
I would not choose Paprosky classification
9%
59/606
Paprosky Type I
1%
10/606
Paprosky Type IIA
5%
31/606
Paprosky Type IIB
16%
101/606
Paprosky Type IIC
11%
67/606
Paprosky Type IIIA
26%
158/606
Paprosky Type IIIB
11%
71/606
Outside my area of expertise - best if I don't vote e
17%
109/606
4. How would you manage this patient?
Nonoperative
0%
6/618
Operative
96%
594/618
Outside my area of expertise - best if I don't vote
2%
18/618
5. If you choose Operative management, what would you do?
I would not choose Operative management
0%
0/614
Resection arthroplasty (e.g. Girdlestone procedure) only
2%
16/614
Open reduction and internal fixation (ORIF)
0%
2/614
Revision arthroplasty only
70%
435/614
Revision arthroplasty + ORIF
21%
133/614
Outside my area of expertise - best if I don't vote
4%
28/614
6. If you choose Revision arthroplasty, which components would you plan on revising?
I would not choose Revision arthroplasty only
0%
1/608
Acetabulum only
79%
484/608
Femur only
0%
4/608
Acetabulum and Femur
16%
99/608
Outside my area of expertise - best if I don't vote e
3%
20/608
7. If you choose Revision arthroplasty of the acetabular component only, what reconstructive technique would you utilize?
I would not choose Revision Arthroplasty of the acetabular component only
0%
2/601
Large Hemispherical Cup with Screws +/- Augments
23%
140/601
Cup with Segmental Allograft
5%
36/601
Cage
1%
8/601
Cup + Cage +/- Augments
48%
293/601
Distraction Techniques with Augments
1%
8/601
Custom Triflange
12%
74/601
Outside my area of expertise - best if I don't vote e
6%
40/601
8. If you choose Revision arthroplasty, what is your choice for the new bearing surface and level of constraint?
I would not choose Revision arthroplasty
0%
1/590
Large metal head on poly
10%
63/590
Large ceramic head on poly
25%
153/590
Dual mobility
48%
286/590
Constrained liner
8%
52/590
Outside my area of expertise - best if I don't vote
5%
35/590
9. If you choose Operative management and attained the construct shown below, what chemical anticoagulation would you use postoperatively?
I would not choose Operative management
0%
0/572
None
0%
2/572
Aspirin (any dose)
21%
124/572
Low molecular weight heparin (ie. Lovenox)
47%
270/572
Direct factor Xa inhibitors (ie. Rivaroxaban, Apixaban, Fondaparinux, etc.)
26%
152/572
Warfarin (ie. Coumadin)
1%
7/572
Outside my area of expertise - best if I don't vote
2%
17/572
10. If you choose Operative management and attained the construct shown below, how would you manage immediate post-operative weight-bearing?
I would not choose Operative management
0%
1/548
Non-weight bearing (NWB)
6%
34/548
Touch-down weight bearing (TDWB)
33%
186/548
Partial weight bearing (PWB, < 25%)
26%
147/548
Weight bearing as tolerated (WBAT)
30%
166/548
Outside my area of expertise - best if I don't vote
2%
14/548
PROCEDURE #1

Revision L THA

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OUTCOMES
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