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THA Revision
Posted: Mar 21 2023 #(C102160) Anterior Hip Foundation 2023 Innovation Symposium
B

Painful Limp Following THA in 62M

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HPI

A 62-year-old male presented with right hip pain and a limp one year following elective anterior total hip arthroplasty. He endorses primarily lateral hip pain with some milder groin pain. The patient states that the hip never felt “right” postoperatively and his symptoms have progressed despite physical therapy and a trochanteric bursa corticosteroid injection.

PMH

The patient underwent MAKO aTHA on 4/11/2022. Implants used in the index procedure included: - Stryker Trident II Solidback Cup 54mm - 54 mm x 36mm polyethylene liner - 36 +0 Biolox ceramic head - Stryker Accolade II femur size 4 - Prophylactic cerclage wire placed without evidence of fracture.

PE

There is a well-healed anterior incision. Gait is Trendelenberg. ROM includes 110 degrees of Flexion, 15 degrees IR and 30 degrees ER. The patient is tender over the greater trochanter. There is no anterior or groin tenderness. Motor strength is 4-/5 with abduction and 5/5 with flexion/adduction.

Poll
1 of 12
In addition to plain AP and LAT radiographs of the affected hip, would you obtain any further imaging to guide your treatment?
Other
Submit
P: 164168
Based on the clinical and radiographic information provided, what do you think is the primary reason for the patient's limp?
Other
Submit
P: 164206
How would you manage this patient?
Other
Submit
P: 164170
If you choose Operative Treatment, what type of treatment would you perform?
Other
Submit
P: 164171
If you choose Direct Abductor Tendon Repair, what approach would you use?
Other
Submit
P: 164212
If you choose Direct Abductor Tendon Repair, would you augment your repair with a graft?
Other
Submit
P: 164184
If you choose Revision Arthroplasty, what component would you revise?
Other
Submit
P: 164172
If you choose to revise the Acetabular Component Alone, which approach would you use?
Other
Submit
P: 164173
If you choose to revise the Acetabular Component Alone, how would you change the position of the cup?
Other
Submit
P: 164208
If you choose to revise the Acetabular Component Alone, what technology would you use to optimize the position of the acetabular component?
Other
Submit
P: 164174
If you choose to revise the Acetabular AND femoral components, which approach would you use?
Other
Submit
P: 164178
If you choose to revise the Femoral components Alone, what would your goals be?
Other
Submit
P: 164214
PROCEDURE #1 DOP: 11/22/2022

Revision Anterior Total Hip Arthroplasty

POLL#
SURGEON CHOICE
1
In addition to plain AP and LAT radiographs of the affected hip, would you obtain any further imaging to guide your treatment?
Yes - CT + MRI
3
How would you manage this patient?
Operative
4
If you choose Operative Treatment, what type of treatment would you perform?
Revision Arthroplasty Alone
7
If you choose Revision Arthroplasty, what component would you revise?
Acetabular Component Alone
8
If you choose to revise the Acetabular Component Alone, which approach would you use?
Direct anterior
9
If you choose to revise the Acetabular Component Alone, how would you change the position of the cup?
Medialize Alone
10
If you choose to revise the Acetabular Component Alone, what technology would you use to optimize the position of the acetabular component?
Fluoro + Nav
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OUTCOMES
one month
Post-procedure P1
17 days
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