57 year old gentleman came to us with complaints of pain in right hip region and inability to walk and bear weight over right lower limb. Patient had past history of trauma to right hip region in the form of fracture acetabulum for which patient underwent primary fixation and Total Hip Replacement elsewhere in 2018. Subsequently patient developed dislocation of right Total Hip Replacement (THR) and underwent revision of acetabulum constrained component at our institute. Patient developed surgical site infection and re-dislocation of previously done hip and came to us for further management.
Pre-op X-Ray pelvis with both hip joints showed dislocated hip with implant in situ
Patient planned for meticulous debridement and definite management for recurrent dislocation of hip. These complex cases required appropriate surgical planning and special surgical instrumentation. Because of previously done multiple surgeries leads to laxity of soft tissues and increases the risk of infection.
This patient underwent thorough surgical site debridement to wash out the infection and one stage re-revision Total Hip Replacement (THR) was done using cemented constrained acetabulum. The femoral stem was also revised to a cemented stem.
50 years lady presented with history of multiple times surgically intervened ipsilateral fracture neck of femur and shaft of femur right lower limb. She presented to us with complaints of pain in right hip region and difficulty in bearing full weight on right leg.
Present xray showed united fracture shaft of femur with plate in situ and nonunion osteotomy site with plate in situ
We did uncemented dual mobility constrained cup with long stem Total Hip Replacement
Now patient is walking comfortably with walker.
60 years female presented to the OPD with progressively increasing pain and limp right hip region for the past 2 yrs.
On examination she had severe deformities of the hip with 3 cm shortening. She was barely able to walk without support
Radiographs showed secondary OA right hip (severe dysplasia)
Management of dysplastic hip is tricky as locating true acetabulum in these cases can be difficult and challenging. Also soft tissue are severely contracted and there is alteration in the morphology of femur & acetabulum. We have done Uncemented Total Hip Replacement with acetabulum at anatomical position which requires expertise.
Now patient is walking comfortably with walker and without limp.
A 48 year old gentleman underwent bilateral primary Total Hip Replacement in 1994. A revision Right Total Hip Replacement(THR) was done in 1997 due to early component loosening. He was comfortable for the last 15 years. He presented to us with complaints in hip and thigh region since last 1 year. Pain had progressively increased over a period of time. On examination there was no gross instability or any evidence of infection. X-rays showed loosening of the femoral component.
A re-revision Total Hip Replacement with uncommented acetabular cup and long uncommented Wagnerstem has been done. Patient was comfortable and walking with a frame at 2 weeks.
SM 62 years female (follow up case of left Total Hip Replacement in 2010) fell down at home and sustained periprosthetic fracture of femur. With increasing number of hip replacements periprosthetic fracture are also becoming common. Managing this fracture is difficult as they are prone to delayed and non union. We routinely get patients with periprosthetic fracture in our department and with time we have gained expertise in treatment of these fractures. In this patient, implant was well fixed so we did Open Reduction and internal fixation (long reverse Distal Femoral Locking Plate). Patient is comfortable and walking with walker.