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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?
Hip flexion contracture
Excessive medialization of the acetabular component
Patient's perceived leg length discrepancy
Hip adduction contracture
Malpositioning of the femoral component
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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?
Lower body weight
Previous total hip replacement on the contralateral side
Lower preoperative hemoglobin
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?
Revision of the acetabular component
Image-guided diagnostic injection of lidocaine into the iliopsoas tendon sheath
Conservative management including activity modifications, NSAIDs, and physical therapy
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.
Ankle arthrodesis in 30 degrees of dorsiflexion
Posterior tibial tendon transfer to the lateral cuneiform through the interosseous membrane
Split anterior tibial tendon transfer to the cuboid
Peroneus longus transfer to the navicular and gastrocnemius recession
Flexor hallucis transfer to the navicular and tendo Achilles lengthening (TAL)
HPI - Inability to weight bear for the last year
Increasing left hip pain over the previous 5 years
Previous left hip surgery in a foreign country > 15 years ago - had mild ongoing hip pain ever since
What type of implant is this?
HPI - THA after femoral neck fracture, pain following start of mobilization 5 days after surgery. No subsidence of the stem after WB
How would you treat this intraoperative peri-prosthetic fracture?
HPI - 2013/10 Bipolar-hemiarthroplasty d/t
2014/09 ORIF c cable grip d/t periprosthetic fx
2014/10/7 CRP was elevated(8~10mg/dl).
2014/10/24 wound problem(redness, pus)
10/31 cable grip removal & antibead insertion
-> Pus was seen lateral aspect of
We considered focal infection due to
We did not expose and irrigate intra-
After latest surgery, CRP elevation(8~10mg/dl) was continued using 1st cephalosporin. After changing 3st cephalosporin, recently two weeks CRP was decreased (1~2mg/dl, above normal)
How would you treat this patient at this time?