Revision Total Hip Replacement

A 59 years old female underwent Total Hip Replacement in 2015 elsewhere. She had a left femur fracture during surgery. The fracture was attempted to be fixed with plate two times at different hospitals. The fracture did not unite. She was bedridden due to this.

She has now undergone revision with wagner stem which bypasses the fracture. She is now walking with support after this surgery.

Revision Total Hip Replacement

Total Hip Replacement – Dysplastic Hip

36 years old lady had developmental dysplasia of right hip. She had limp while walking since childhood and now had severe pain in walking. Her right leg was short by 3 cm.
We did Uncemented Total Hip Replacement in which we create new artificial joint restoring the normal hip biomechanics . Total Hip Replacement in dysplastic hip is technical challenging surgery and very few centres across India are successfully performing this surgery. Now her legs are equal and her walk has improved. She is very happy with the result of surgery.


Re-Revision Total Hip Replacement

72 year old male whose primary THR was done in 1991 and revision THR for aseptic loosening was done in 2006 (both surgeries were performed elsewhere) presented to us with pain and instability.

Radiographs showed loose isoelastic acetabular cup and subluxed femoral head.

3D tissue printing images showed significant defect in the postero – superior wall of the acetabulum. 3D tissue printing is a new technology available at very  few centers in country which allows precise preoperative planning of each patient.

Re-revision of the acetabular cup was done with an uncemented cup and around 40-50% of cup was found to be uncovered in the posterosuperior area for which a trabecular metal augment and autograft was used. Oxinium femoral head was implanted. Femoral stem was found to be well-fixed and was left in-situ. Patient was walking with walker support on second post operative day, he is relieved of pain and has regained limb length.

Two stage Revision TKR with RHK and Stem Extender and Metallic Augment

62 years gentleman presented to us with infected Right TKR which was performed 1 year ago elsewhere.

A 2 stage revision TKR was planned. In the first stage primary prosthesis was removed, thorough debridement was done and customized, mobile antibiotic cement spacer was placed in situ. Antibiotics were given for a total of 6 weeks till the infection was eradicated. 8 weeks later 2nd stage revision TKR done with RHK (Rotating Hinge Knee) and Stem Extender and Metallic Augment ( Distal and Posterior Femur Augments / Wedges).

Patient is comfortable and walking pain free with full weight bearing with no sign suggestive of recurrence of infection.

Revision TKR in the scenario of infection is challenging. At our center we have successfully managed many such cases.

Revision Total Knee Replacement With Megaprosthesis

39 male gentleman presented to us with infection of left side knee. He had a history of proximal tibial tumour (osteosarcoma) which was treated by tumor resection and endoprosthesis 1 year back. He was in severe pain and was unable to bear weight on left side lower limb. Managing Infected Knee Replacement is a challenge and very few centres in India are managing these cases.

We at our centre follow 2 stage protocol for treatment of these case. In 1st stage the implants are removed and thorough debridement is done to clear of all the infection and antibiotic spacer are put for 3 months to clear the residual infection.

In 2nd Stage the antibiotic spacer are removed and revision Total Knee Implants are put. Patient can walk from 2nd post op day after this surgery. After surgery our patient is comfortable and walking independently. There are no signs of residual infection.

revision-total-knee-repllacement-t-k-r-of-deepak-agarwal- by Dr Shekhar Agarwal