Updated: 2/8/2017

THA Other Complications

Topic
Review Topic
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0
Questions
31
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0
Evidence
46
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0
Videos
2
Cases
4
https://upload.orthobullets.com/topic/5030/images/leg length.jpg
https://upload.orthobullets.com/topic/5030/images/acetabular overhand with normal anteversion.jpg
https://upload.orthobullets.com/topic/5030/images/ho.jpg
Introduction
  • This topic includes
    • heterotopic ossification
    • squeaking
    • blood transfusion
    • pseudotumor (metal reactions)
    • vascular injury
  • Other THA Complication topics
    • periprosthetic infection 
    • THA dislocation 
    • periprosthetic fractures 
    • aseptic loosening 
    • limb length discrepancy 
    • sciatic nerve palsy 
Heterotopic Ossification
  • Introduction
    • frequent complication that may limit functional outcome following hip replacement  
    • risk factors
      • prolonged surgical time
      • excessive soft tissue handling during procedure
      • hypertrophic osteoarthritis
      • male gender
  • Treatment
    • surgical excision
      • indications
        • severe loss of motion
        • once heterotopic ossification is visible on radiographs, only surgical excision will eradicate 
      • technique
        • must wait 6 months after initial procedure to allow for maturation and formation of capsule
        • perioperative prophylaxis with perioperative radiation or NSAIDs
  • Prophylaxis
    • oral indomethacin
    • radiation therapy
      • 600-800 cGy administered ideally within 24-48 hours following procedure
Postoperative Anemia
  • Low preoperative hemoglobin
    • is the best predictor of the need for a blood transfusion postoperatively 
  • Prevention
    • TXA
  • Treatment
    • postoperative transfusion
      • indications
        • most centers have dropped to a hemoglobin of 7-8
Squeaking
  • Defined as a high pitched audible sound occurring during hip movement
  • Incidence
    • ceramic-on-ceramic 
      • 0.5-10%
    • metal-on-metal 
      • 4-5%
    • incidence of revision because of squeaking is 0.5%
  • Risks 
    • impingement
    • edge loading
    • component malposition
    • loss of fluid film lubrication
    • third body particles
    • thin, flexible (titanium) femoral stem 
Pseudotumor Hypersensitivity Response
  • Introduction
    • caused by metal-on-metal THA relating to metallic wear  
      • With metal-on-metal THA, current recommendations are to obtain serum metal ion levels (cobalt, chromium) at long-term followup visits
      • If any concerns, imaging of choice is MR with metal subtraction
      • In symptomatic patients, must first rule out infection, fracture or other causes of acute or chronic pain before presuming metallic wear and ordering metal ion levels
    • lesion, neither infective or neoplastic, which develops in the vicinity of a total hip replacement
  • Presentation
    • associated with pain, and bone erosion
Vascular Injury
  • Incidence
    • 0.1%-0.2%
  • Risk factors
    • acetabular screw placement in anterior-superior quadrant
    • inappropriate retractor placement 
 

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Questions (31)
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(OBQ06.141) The preoperative pelvic radiograph of a 63-year-old female with osteoarthritis is shown in Figure A. She undergoes an uncomplicated total hip replacement. Six weeks post-operatively she complains that her right leg is longer than her left, and an AP pelvic radiograph is obtained which is shown in Figure B. Physical exam shows normal post-operative range of motion and strength in both hips. What is the most likely etiology for this patients gait impairment? Review Topic

QID: 327
FIGURES:
1

Hip flexion contracture

3%

(53/1881)

2

Excessive medialization of the acetabular component

1%

(21/1881)

3

Patient's perceived leg length discrepancy

88%

(1653/1881)

4

Hip adduction contracture

6%

(116/1881)

5

Malpositioning of the femoral component

2%

(33/1881)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3
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(OBQ08.189) A 65-year-old female scheduled to undergo a total hip replacement is concerned about the need of a blood transfusion. The surgeon should explain that which factor is the best predictor of the need for a blood transfusion? Review Topic

QID: 575
1

Shorter height

0%

(1/1310)

2

Lower body weight

1%

(12/1310)

3

Previous total hip replacement on the contralateral side

1%

(15/1310)

4

Lower preoperative hemoglobin

97%

(1267/1310)

5

Female gender

1%

(9/1310)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ12.234) A 67-year-old female complains of anterior groin pain one year following a primary, uncemented total hip arthroplasty. The pain is exacerbated when she tries to climb stairs or get up from a seated position. She denies any recent fevers or chills. On physical exam, the pain is reproduced with resisted seated hip flexion. Laboratory analysis, including WBC, ESR, and CRP are within normal limits. Radiographs reveal that the components are appropriately positioned without evidence of loosening or fracture. Which of the following is the most appropriate at this time? Review Topic

QID: 4594
1

Revision of the acetabular component

1%

(24/3180)

2

Image-guided diagnostic injection of lidocaine into the iliopsoas tendon sheath

77%

(2450/3180)

3

Hip aspiration

3%

(107/3180)

4

Bone scan

5%

(174/3180)

5

Conservative management including activity modifications, NSAIDs, and physical therapy

13%

(409/3180)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ12.164) A 45-year-old man has had the gait disturbance shown in Video A ever since a total hip replacement two years ago. Since then he has undergone physical therapy and nerve exploration without any clinical improvement. Extensive AFO bracing was attempted but was not tolerated by the patient. A recent ankle radiograph is shown in Figure A. The Silfverskiold test reveals dorsiflexion of 20 degrees with knee flexion, and 10 degrees with full knee extension. The results of muscle testing using a Cybex dynamometer are shown in Figure B. What is the most appropriate next step in in treatment. Review Topic

QID: 4524
FIGURES:
1

Ankle arthrodesis in 30 degrees of dorsiflexion

1%

(27/3127)

2

Posterior tibial tendon transfer to the lateral cuneiform through the interosseous membrane

75%

(2334/3127)

3

Split anterior tibial tendon transfer to the cuboid

3%

(109/3127)

4

Peroneus longus transfer to the navicular and gastrocnemius recession

6%

(195/3127)

5

Flexor hallucis transfer to the navicular and tendo Achilles lengthening (TAL)

14%

(439/3127)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
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ARTICLES (80)
VIDEOS (2)
CASES (4)
Topic COMMENTS (33)
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