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A 72-year-old male presents with worsening left hip pain 12 years after total hip arthroplasty. On examination, the patient has a Trendelenburg gait with a 3.5 cm leg length discrepancy. The patient denies any fevers or chills. Current radiographs are shown in figure A. Recent ESR and CRP are 21 mm/hr and 1.2 mg/L, respectively. What is the preferred treatment option to address these findings?
Large porous hemispheric cup with particulate bone graft and augmented with screw fixation
Custom triflanged acetabular component
Cemented large porous hemispheric cup
Metal augments with large porous hemispheric cup and bone grafting combined with screw augmentation
2-stage revision arthroplasty
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Figure A depicts the current radiograph of a 66-year-old man with significant right groin pain after undergoing right total hip arthroplasty (THA) 10 years ago. Revision surgery is planned after infection workup is negative. What is the classification of his diagnosis and what would the most appropriate treatment for the acetabulum?
Paprosky I; cementless hemispheric cup with screw fixation
Paprosky I; cemented hemispheric cup without screw fixation
Paprosky IIB; cementless hemispheric cup with screw fixation
Paprosky IIIA; cup/cage construct
Paprosky IIIA; triflange reconstruction
A 77-year-old patient presents with progressively worsening right hip pain and limp. The patient underwent a right revision total hip arthroplasty 15 years ago and is now unable to ambulate due to the pain and feels as if the hip is unstable. The patient's radiograph is shown in Figure 1. Which of the following is the appropriate classification and best treatment approach for this patient?
Paprosky 2A; multihole cup with posterior column plating
Paprosky 2B; antiprotrusio cage with structural allograft
Paprosky 3A; distraction arthroplasty
Paprosky 3B; custom triflange cup
Paprosky 3B; cemented cup
An 80-year-old female presents following a fall from standing. She was an active, independent, community ambulator prior to this event. Past surgical history is significant for a left total hip arthroplasty 10 years prior. A left hip XR is obtained and shown in Figure A. A CT is obtained and demonstrates a displaced transverse acetabulum fracture with medial cup migration. There is no evidence of femoral component loosening or fracture. There is no concern for infection and all inflammatory markers are within appropriate limits. Which treatment is most appropriate?
Restricted weight bearing
Acetabular revision with a custom triflange implant
Dual approach pelvic ORIF and acetabular revision
Acetabular revision with cup-cage construct
Acetabular revision with placement of a jumbo cup
A 65-year-old male presents to your clinic for evaluation of right hip pain. He underwent a right total hip arthroplasty (THA) 20 years prior and was doing very well until 2 years ago. He admits to groin pain when getting up from a seated position. He denies any fevers or chills. Radiograph is shown in Figure A. Which of the following would preclude the patient from undergoing a single-stage surgical intervention without further workup?
Elevated serum cobalt
Metallosis noted intra-operatively
Significantly higher serum cobalt then serum chrome levels
Elevated ESR and CRP
Pseudotumor noted on MRI
A 72-year-old patient is scheduled to undergo revision total hip arthroplasty. A 3D-model of the patient's hemipelvis is constructed for pre-operative planning and is shown in Figure A. A custom-designed implant shown in Figure B is created. Which of the following is TRUE of the planned reconstruction?
The implant is a bilobed cup.
The most common complication is dislocation.
The acetabular defect can be classified as AAOS Type V.
Radiation-compromised bone stock is a contraindication.
The winged profile of the implant facilitates insertion through both anterior and anterolateral approaches.
A 71 year old gentleman underwent left total hip arthroplasty 10 years ago. Eighteen months ago he began having hip and thigh pain. Over the past 6 weeks, the pain has become excruciating and he has been unable to ambulate, even with the aid of a walker. He has mild pain with passive internal and external rotation of the hip. He is unable to ambulate in the office. Laboratory values are notable for a WBC of 10,300, CRP of 0.2, and ESR of 13. A radiograph is provided in figure A. Which of the following is the best treatment option?
Radionuclide bone scan and MRI
Open reduction internal fixation with a cable plate and allograft strut
Revision arthroplasty with a fully coated cementless stem, cable wiring, and bone graft
Revision arthroplasty with a modular, tapered stem and bone grafting of the diaphyseal fixation
Revision arthroplasty with a total femur prosthesis
Which of the following statements is true regarding the thirty-year follow-up data obtained from the Charnley "low-friction" total hip arthroplasty?
Acetabular component failure was the least common reason for revision surgery
The number of revisions required for periprosthetic fractures was higher than that for deep infections
Acetabular component failure was a more common reason for revision than deep infection
Femoral component failure was a more common reason for revision than acetabular component failure
Deep infection was the most common reason for revision
A 91-year-old male with a history of chronic leukemia and dementia falls and sustains the hip fracture shown in Figure A. He undergoes a hemiarthroplasty through a posterior approach. A post-operative radiograph is shown in Figure B. Three weeks later he dislocates the hip arising from the toilet seat. A radiograph is shown in Figure C. The patient undergoes a closed reduction and is placed in a hip abduction brace. Post reduction radiograph is shown in Figure D. One month later he returns to clinic complaining of pain and inability to bear weight through the leg. A radiograph of the hip is included in Figure E. Which of the following factors has MOST likely contributed to the instability of the hip hemiarthroplasty?
Femoral stem subsidence
Inadequate femoral stem neck length
Patient's dementia status
A 72-year old female who underwent an uncemented right total hip arthroplasty 2 years ago complains of right hip pain after a fall. Figure A shows her current radiograph. Which acetabular bone defect classification and treatment option best describes this scenario?
AAOS Type III - anti-protrusio cage with augmentation and a posterior column plate
AAOS Type IV - anti-protrusio cage with screw fixation and a posterior column plate
AAOS Type II - jumbo cup with augmentation and a posterior column plate
AAOS Type I - total acetabular allograft with a cemented cup
AAOS Type II - custom triflange acetabular component
A 74-year-old man presents with start-up thigh pain following a total hip replacement 10 years ago. Immediate post-operative radiograph is shown in Figure A. A current radiograph is shown in Figure B. Aspiration of the hip yields 1,005 white blood cells/ml. ESR is 12 (normal <40) and CRP is 0.4 (normal <1.2). Which of the following is the most appropriate management at this time?
Revision of the femoral component to an uncemented, long, fully porous-coated stem
Revision of the femoral component to a cemented stem
Revision of the femoral component to an allograft prosthetic composite
Revision of the femoral component to a proximal femoral replacement
Removal of prosthesis with insertion of antibiotic spacer
A 71-year-old woman with coronary artery disease underwent an uncomplicated right total hip arthroplasty for osteoarthritis 12 years ago. Her hip has functioned well until approximately 18 months ago when she noted the spontaneous onset of groin, buttock, and proximal thigh pain that is present at rest and made worse with activity. A radiograph is shown in Figure 15. What is the recommended management at this point?
Immediate admission to the hospital and emergent revision hip arthroplasty
Reassurance and follow-up if symptoms worsen
Repeat radiographs in 1 month
Protected weight bearing with urgent revision hip arthroplasty when the patient is medically cleared
A prescription for alendronate and reevaluation in 1 year
Which of the following is true regarding the conversion of hip arthrodesis to total hip arthroplasty?
Implant survivorship is greater than 95% at 20 years following conversion to arthroplasty
Conversion to arthroplasty should not be performed if arthrodesis is more than 15 years old
Function of gluteus medius is predictive of ambulatory status
Rate of complication is equivalent to primary total hip arthroplasty
Incidence of nerve palsy is comparable to primary total hip arthroplasty
A 85-year-old man who underwent hemiarthroplasty 5 years ago now complains of thigh pain for the past four months. Laboratory studies show a normal white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An aspiration of the hip is performed and is negative for infection. A radiograph is shown in Figure A. Which of the following is the best management option for the femoral implant?
Bone scan to look for loosening
Touch down weight bearing and physical therapy
Revision with a tumor prosthesis
Revision of femoral component with metaphyseal cement fixation of the stem
Revision to a cementless femoral component with diaphyseal press-fit fixation of the stem
A 67-year-old female with history rheumatoid arthritis presents with acute onset severe left hip pain eight years status-post total hip arthroplasty. She is unable to weight bear on the left leg, but denies any other pain or systemic symptoms. A current radiograph of the pelvis is shown in Figure A. What is the most likely cause of the patient's current hip pain symptoms?
Poor surgical technique
Rheumatoid arthritis flare
Catastrophic implant failure
Development of pelvic discontinuity
What are the optimal conditions for leaving the acetabular shell in place, replacing the acetabular liner, and grafting the osteolytic defect shown in Figure 39?
Well-designed, well-fixed modular implant
Complete radiolucency of the acetabular component
Migration of the acetabular component
Figure 44 shows the radiograph of a 65-year-old man who underwent a revision arthroplasty to remove a loose, cemented femoral stem. When planning the postoperative restrictions, the surgeon should be aware that
the approach used reduces the torque-to-failure (fracture) of the construct to less than 50% of the intact femur.
the technique of repair can return the reconstructed prosthesis/bone composite to nearly the strength of the intact femur.
there is no relationship between the density of the native bone and the strength of the prosthesis/bone composite.
the addition of bone graft substitute or autograft has been shown to lessen the time to complete healing.
there is a one in five chance of fracture with this technique; therefore, the surgeon must carefully weigh the potential benefits versus this risk.
A 72-year-old woman who underwent right total hip arthroplasty 7 years ago now reports right hip pain and limb shortening. Studies for infection are negative. AP and lateral radiographs are shown in Figures 13a and 13b. What is the most appropriate management?
Nonsteroidal anti-inflammatory drugs and protected weight bearing
Revision of the acetabular component with a jumbo cup with screws
Revision of the acetabular component with a reinforcement cage and bone grafting
Figure A shows an AP hip radiograph of a 72-year-old woman who had had a right total hip arthroplasty fifteen years previously. CT imaging of the affected hip shows non-contained defects in both the anterior and posterior columns of the peri-acetabular region affecting greater than 50% of the weight bearing surface. Which of the following revision procedures would restore the most acetabular bone stock and be most appropriate for this patient?
Morselized allograft and/or autograft bone, combined with a cemented acetabular component
Acetabular revision with use of a bilobed cementless component and morselized allograft
Morselized allograft and/or autograft bone, combined with a cementless acetabular component
Revision using an ilioischial reconstruction ring acetabular component and structural corticocancellous graft
Revision using a roof ring acetabular component and structural corticocancellous graft