55 years old lady came to us with complaints of left hip pain and difficulty in bearing weight on left lower limb for the past 3 months. She underwent hip replacement surgery (THR) in 1995 followed by revision THR (2000 & 2008) elsewhere. On Clinical examination there were no signs of infection. There was shortening of 4 cm on left side.
Infection markers were negative. Preoperative x ray showed aseptic loosening of both acetabular socket and femoral stem. There was huge defect in acetabulum.
We further evaluated this case with CT scan which showed large anterior and superior bone defect while the posterior bone stock was good. We also prepared a 3D model of acetabulum preoperatively to study the defect and procure all the implants as backup for filling the defect. This 3D model was made under the guidance of Dr Shekhar Agarwal and team.
3D printing is the latest technology in Orthopaedics where we can have actual 3D model of bone and plan our surgery accordingly. 3D model exactly replicates actual bone defects which helps the surgeon to plan the surgery.
At Sant Parmanand Hospital we have this facility of 3D printing that we use in cases of difficult surgeries. As per our preoperative planning we did revision Total Hip Replacement (THR). Allograft bone was used to fill the acetabular defect and Trabacular metal jumbo acetabular cup was used. Uncemented long stem Wagner femoral stem was used on the femur. Now patient is comfortable and walking with support.
At Delhi Institute of Trauma & Orthopaedics, in Sant Parmamand Hospital, we perform very complex knee and hip replacement surgery. One of the most complicated types of joint replacement surgery is revision hip replacement surgery. This surgery involves removing a previous implant that was in the hip joint that has become damaged due to injury or wear and tear and replacing it with new more advanced hip implants. This requires extremely high surgical technique and the surgery can often last many hours as the surgeon has to take many factors into consideration such as the age of the patient, the type of bone quality he observes in the patient, and the extent of damage found inside the joint or adjacent areas.
As an example, a 53 year old gentleman was presented to our hospital with pain in the right hip following a road traffic accident. He had a total hip replacement done 10 years prior to the accident and was walking comfortably before the accident. X-rays revealed a fracture of the pelvic bone (acetabulum) with posterior dislocation of the acetabular component. Fixation of the acetabulum fracture with screws followed by revision of the acetabular component with an uncemented cup was performed. As the femoral component was well fixed, it was not revised.
Essentially in this patient, we had to revise one component of the hip implant, and add screws in the pelvic area to give support to that area so that the bone unites where fractured. Post operatively, the patient is walking comfortably.
Delhi Institute of Trauma & Orthopaedics is one of the leading orthopaedic hospitals in India. Our teams of surgeons are dedicated to learning and practicing the most advanced surgical techniques and handling the most complex surgical cases.