Posted: Jan 17 2021 #(C101699)

Pelvic Discontinuity with Periprosthetic Osteolysis in 88M

HPI

An 88-year-old male presents with severe right hip pain following a recent fall. He underwent a right total hip replacement (1995) and prior to the fall, he had minimal pain, was living independently, and ambulated with a cane for long distances only. He is now unable to ambulate. He denies fever, chills, or additional surgeries since his index procedure. He has not been seen by an orthopedic surgeon in 20 years.

PMH

His medical history is significant for BPH and hypertension. He underwent a right total hip arthroplasty in 1995. His ESR and CRP are within normal limits.

Focused physical examination reveals a well-healed posterolateral hip incision. The right lower extremity is 7mm shorter than the left lower extremity. There is pain with attempted ROM of the hip. Unable to assess abductor function due to pain. He is neurovascularly intact

Poll

1 of 10

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

No - Current radiographs are sufficient

52/647

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

10/647

Yes - CT pelvis (CT)

74%

483/647

Yes - MRI pelvis (MRI)

8/647

Yes - aXR + CT

64/647

Yes - aXR + MRI

2/647

Yes - CT + MRI

16/647

Yes - aXR + CT + MRI

6/647

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

6/647

2. How would you manage this patient?

Nonoperative

12/633

Operative

96%

612/633

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

9/633

3. If you choose Operative management, what would you do?

I would not choose Operative management

2/636

Resection arthroplasty (e.g. Girdlestone procedure) only

18/636

Open reduction and internal fixation (ORIF)

10/636

Revision arthroplasty only

52%

336/636

Revision arthroplasty + ORIF

38%

248/636

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

22/636

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

I would not choose Operative management

1/620

Posterolateral

72%

450/620

Lateral

12%

80/620

Anterolateral

56/620

14/620

Other

2/620

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

17/620

5. If you choose Revision arthroplasty, which components would you revise?

I would not choose Revision arthroplasty

1/617

Acetabulum only

64%

397/617

Femur only

3/617

Acetabulum + Femur

33%

204/617

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

12/617

6. If you choose Revision Arthroplasty, how would you address the acetabulum?

I would not choose Revision arthroplasty

0/604

I would not address the acetabulum

0/604

Jumbo cup with pelvic distraction

28/604

Jumbo cup with augments (metal or allograft)

18%

114/604

Cup-cage +/- augments (metal or allograft)

60%

363/604

Custom triflange

12%

74/604

Other

4/604

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

21/604

7. If you choose Revision Arthroplasty, how would you address the femur?

I would not choose Revision arthroplasty

19/589

I would not address the femur

57%

341/589

Revise to cemented stem

13%

80/589

Revise to monolithic stem

24/589

Revise to modular stem

18%

107/589

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

18/589

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

I would not choose operative management

1/576

Large metal head on poly

24%

143/576

Large ceramic head on poly

16%

93/576

Dual mobility

49%

283/576

Constrained liner

35/576

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

21/576

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

I would not choose operative management

0/569

No - preoperative workup is sufficient

22%

130/569

Yes - Intraoperative cell count and cultures only

34%

198/569

Yes - Intraoperative frozen only

22/569

Yes - Intraoperative cell count, frozen and cultures

36%

206/569

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

13/569

10. If you choose Operative management and attain the construct below, how would you manage immediate post-operative weight-bearing?

I would not choose operative management

0/551

NWB

14%

78/551

TDWB/TTWB

26%

144/551

PWB (< 25-50%)

29%

165/551

WBAT immediately

27%

153/551

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

11/551

Post-procedure P1

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