Introduction Macrophage-induced inflammatory response resulting in bone loss Steps in the process include prosthesis micromotion particulate debris formation macrophage activated osteolysis see wear and osteolysis basic science for full description Presentation Symptoms pain location groin pain thigh pain knee pain aggrevating factors often activity related Physical exam may have minimal pain with ROM increased pain with weight bearing Imaging Radiographs recommended views AP lateral findings (xrays are not sensitive for osteolysis and typically underestimate extent of involvement) lucency > 2 mm at cement-bone or metal-bone interface component motion with stress views femoral component subsidence > 1 cm fracture of cement mantle change in peg-neck angle can also represent femoral head necrosis/collapse, femoral neck fracture decreased distance from tip of peg to lateral femoral cortex can also represent femoral head necrosis/collapse narrowing of femoral neck after 3 years or > 10% can also represent impingement acetabular component migration or change in position/inclination wearing of polyethylene liner leads to asymmetric superior location of femoral head within acetabular cup Studies Serum labs ESR will be normal CRP will be normal Treatment Nonoperative observation indications stable implant with minimal symptoms Operative revision THA Indications pain due to aseptic loosening pain with evidence of osteolysis extensive osteolysis that would compromise revision surgery in the future.
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.164) Figure A and B are radiographs of a 77-year-old patient presenting with right hip and upper thigh pain for the past 3 months. He is an avid golfer and plans to travel south for 6 months on a golf tour. He denies fever, chills or weight loss. His past medical history includes hypertension and a right total hip replacement 15 years ago. Physical examination reveals minimal pain with range of motion. ESR=10 (normal range 0-20) and CRP=4 (normal range 0-10). He does not want any further surgery. The patient is at the highest risk of which complication with non-operative care? Review Topic | Tested Concept QID: 4799 FIGURES: A B Type & Select Correct Answer 1 Infection 0% (17/4112) 2 Pseudotumour formation 1% (28/4112) 3 Periprosthetic femoral fracture 94% (3865/4112) 4 Periprosthetic acetabular fracture 0% (17/4112) 5 Dislocation 4% (153/4112) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07HK.99) Which of the following statements best describes results that have been reported with roentgen stereophotogrammetric analysis (RSA)? Review Topic | Tested Concept QID: 6059 Type & Select Correct Answer 1 Cemented total hip stems do not migrate. 2% (6/396) 2 Well-fixed total hip stems (cemented or cementless) migrate approximately 3 degrees and 5 mm in the first year. 12% (48/396) 3 Any early migration (ie, greater than 0 mm less than 6 months after surgery) portends failure of the component. 8% (30/396) 4 Migration greater than 1 mm to 2 mm in the first year is associated with a higher risk of loosening. 60% (238/396) 5 The system has been proven to not be as accurate as claimed and has been abandoned. 18% (71/396) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept
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