Painful Total Hip Arthroplasty in 58M

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PRESENTATION
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POLLS
5,799
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OUTCOMES
6
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VIDEOS
3
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EVIDENCE
26
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Comments
38
CASE DESCRIPTION
AGE 58 / Male
CC L hip pain
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
Pre-procedure IMAGES:
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POLLS
OB Community
1) In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
Other
2) Would you use a classification system to guide management?
Other
3) If you choose the Paprosky classification, would you classify this acetabular defect?
Other
4) How would you manage this patient?
Other
5) If you choose Operative management, what would you do?
Other
6) If you choose Revision arthroplasty, which components would you plan on revising?
Other
7) If you choose Revision arthroplasty of the acetabular component only, what reconstructive technique would you utilize?
Other
8) If you choose Revision arthroplasty, what is your choice for the new bearing surface and level of constraint?
Other
9) If you choose Operative management and attained the construct shown below, what chemical anticoagulation would you use postoperatively?
Other
10) If you choose Operative management and attained the construct shown below, how would you manage immediate post-operative weight-bearing?
Other
CASE OUTCOMES
PROCEDURE 1: Revision L THA
Intra-procedure P1
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Post-procedure P1
https://upload.orthobullets.com/cases/102028/30b56919-26f0-4580-98c1-c07380e4f052_bs_postop_ap.jpg https://upload.orthobullets.com/cases/102028/34fd3f52-dd7a-414e-8c21-7b346ac3a1c4_bs_postop_2.jpg
VIDEOS & PODCASTS (3)
EVIDENCE (26)
EXPERT COMMENTS