Updated: 6/10/2021

THA Other Complications

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  • Introduction
    • This topic includes
      • heterotopic ossification
      • squeaking
      • blood transfusion
    • Other THA Complication topics
      • periprosthetic infection
      • THA dislocation
      • Iliopsoas impingement 
      • periprosthetic fractures
      • THA pseudotumor 
      • aseptic loosening
      • limb length discrepancy
      • sciatic nerve palsy
      • THA trunnionosis 
      • Vascular injury and bleeding 
  • 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
        • ankylosing spondylitis 
    • 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
  • 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
  • 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

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Flashcards (2)
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Questions (15)

(OBQ13.121) A 55-year-old patient returns for followup 2 years after a left ceramic-on-ceramic total hip arthroplasty. He has no pain or symptoms of instability. The video in Figure V shows him ascending stairs. All of the following factors may contribute to this phenomenon EXCEPT

QID: 4756
FIGURES:
1

Impingement

5%

(200/3888)

2

Edge-loading

8%

(292/3888)

3

Loss of fluid film lubrication.

9%

(365/3888)

4

Third-body particles

4%

(143/3888)

5

Subclinical infection

73%

(2854/3888)

L 3 C

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(SAE07HK.85) A 62-year-old patient is seen for routine follow-up after undergoing cementless total hip arthroplasty 2 years ago. The patient reports limited range of motion that severely affects daily activities. A radiograph is shown in Figure 51. Management should now consist of

QID: 6045
FIGURES:
1

observation only.

1%

(2/391)

2

nonsteroidal anti-inflammatory drugs and protected weight bearing.

2%

(6/391)

3

irradiation to the affected area.

2%

(9/391)

4

surgical excision.

15%

(58/391)

5

surgical excision and postoperative irradiation.

79%

(310/391)

L 1 E

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(SAE07HK.80) Figure 49 shows a histologic section of the lung in a patient who died during total hip arthroplasty. What unexpected finding is seen in the pulmonary capillaries?

QID: 6040
FIGURES:
1

Pulmonary embolism

21%

(108/506)

2

Methylmethacrylate cement

67%

(339/506)

3

Hemorrhagic infarct

8%

(42/506)

4

Granuloma formation

1%

(6/506)

5

Amyloid

1%

(6/506)

N/A E

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(SAE07HK.47) A 58-year-old patient who underwent bilateral hip arthroplasty 12 years ago now reports pain in his hips and difficulty with ambulation to the point where he now uses crutches. A radiograph of the hip and pelvis is shown in Figure 26. What is the best treatment option for this patient?

QID: 6007
FIGURES:
1

Revision hip arthroplasty with a bipolar implant

2%

(7/340)

2

Revision hip arthroplasty with impaction grafting on the femoral and acetabular side

7%

(23/340)

3

Revision hip arthroplasty with a cemented jumbo acetabular component

34%

(116/340)

4

Revision hip arthroplasty with a cementless acetabular component

46%

(155/340)

5

Acetabular component revision with a tri-flange protrusio ring

11%

(38/340)

L 4 E

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(SAE07HK.41) Figure 23 shows failure of the femoral stem in a patient. What is the most likely reason for the failure?

QID: 6001
FIGURES:
1

Torsional loading

6%

(22/374)

2

Cantilever bending

79%

(297/374)

3

Pistoning

5%

(17/374)

4

Subsidence

5%

(18/374)

5

Torque

3%

(10/374)

L 2 E

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Evidence (91)
VIDEOS & PODCASTS (9)
CASES (3)
EXPERT COMMENTS (33)
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