Posted: Apr 3 2022 #(C102028) ICJR 9th Annual Revision Hip & Knee Course

Painful Total Hip Arthroplasty in 58M

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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

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

In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?

No - Current radiographs are sufficient

12%

(84/655)

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

(23/655)

Yes - CT pelvis (CT)

63%

(413/655)

Yes - MRI pelvis (MRI)

(16/655)

Yes - aXR + CT

(56/655)

Yes - aXR + MRI

(4/655)

Yes - CT + MRI

(26/655)

Yes - aXR + CT + MRI

(14/655)

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

(19/655)

Would you use a classification system to guide management?

No - a classification system would not help me

35%

(223/631)

Yes - AAOS

(33/631)

Yes - Paprosky

53%

(340/631)

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

(35/631)

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

I would not choose Paprosky classification

(59/591)

Paprosky Type I

(10/591)

Paprosky Type IIA

(29/591)

Paprosky Type IIB

16%

(99/591)

Paprosky Type IIC

11%

(66/591)

Paprosky Type IIIA

25%

(151/591)

Paprosky Type IIIB

11%

(70/591)

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

18%

(107/591)

How would you manage this patient?

Nonoperative

(6/604)

Operative

96%

(581/604)

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

(17/604)

If you choose Operative management, what would you do?

I would not choose Operative management

(0/599)

Resection arthroplasty (e.g. Girdlestone procedure) only

(16/599)

Open reduction and internal fixation (ORIF)

(2/599)

Revision arthroplasty only

70%

(424/599)

Revision arthroplasty + ORIF

21%

(131/599)

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

(26/599)

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

I would not choose Revision arthroplasty only

(1/593)

Acetabulum only

79%

(473/593)

Femur only

(3/593)

Acetabulum and Femur

16%

(98/593)

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

(18/593)

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

(2/585)

Large Hemispherical Cup with Screws +/- Augments

23%

(135/585)

Cup with Segmental Allograft

(35/585)

Cage

(8/585)

Cup + Cage +/- Augments

48%

(285/585)

Distraction Techniques with Augments

(8/585)

Custom Triflange

12%

(74/585)

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

(38/585)

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

I would not choose Revision arthroplasty

(1/575)

Large metal head on poly

10%

(60/575)

Large ceramic head on poly

25%

(149/575)

Dual mobility

48%

(280/575)

Constrained liner

(52/575)

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

(33/575)

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

I would not choose Operative management

(0/558)

None

(2/558)

Aspirin (any dose)

21%

(119/558)

Low molecular weight heparin (ie. Lovenox)

47%

(266/558)

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

26%

(149/558)

Warfarin (ie. Coumadin)

(6/558)

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

(16/558)

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

(1/533)

Non-weight bearing (NWB)

(33/533)

Touch-down weight bearing (TDWB)

34%

(183/533)

Partial weight bearing (PWB, < 25%)

27%

(145/533)

Weight bearing as tolerated (WBAT)

29%

(159/533)

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

(12/533)

Intra-procedure P1

Post-procedure P1

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