Wednesday, 18 July 2012

Complex Hip- OA with intertroch nonunion with implant in situ

Any takers for this complex hip pics send to me by my good friend 

 He managed put a stem  between the screws had a problem with the  osteopenic trochanter and possibly cup both of which could contribute to instabilty which is what happenend  in time

 Charan whats the problem now and solutions
 as expected  the hip dislocated


The options now
The cup appears too anteverted as well as vertical. . with a flying trochanter adding to the problem.

 my advise is to revise the cup. use larger head if possible and use a trochanteric cable plate.if the troch is too soft to hold  wire over a titanim mesh. if this does not work only a capture cup or a tripolar head is the only solution.

My friend revised the cup and stabilised the hip. his trochanter has dissapeared. In this situation anchor the glutea to the reamaning bone or if that is not possible anchor the two flaps of TFL  to bone  leaving the distal portion free to inset distally. Abductor bace for 6 weeks

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3 comments:

  1. Dr Jacob Varghese18 July 2012 at 15:34

    Problems - abductor insufficiency
    retained implant
    ? infection

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  2. sreecharan20 July 2012 at 20:05

    Hello sir,
    I think we should do a staged revision where we can do an excision arthroplasty,try to remove the broken screws(possible with a hollow mill), antibiotic coated pellet insertion and tissue for C/S and iv antibiotics for 6 weeks. stage II we can use a distal loading stem and a peripheral fitting cup revision cup. I also feel we could get away with a primaru cup.

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  3. Dr Jacob Varghese26 July 2012 at 18:59

    I do agree with you charan. if financially challenged one might get a c stem in between the screws. of course removal and long stem or even stem just distal 2 diameters to the screw would be ideal

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