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Reconstructive Arthroplasty for High-Risk Hip Replacement
Reconstructive Arthroplasty for High-Risk Hip Replacement
This archive analyzes the clinical management of high-risk Total Hip Replacements, focusing on the technical resolution of bone loss, radiation-induced necrosis, and periprosthetic nerve injury.
On this page we present cases of interest in hip replacement surgery. They are challenging problems and require the treating physician to evaluate the risks of infection, bone loss, dislocation and nerve injury. Often they will need allograft supplementation and specialised implants but the ideal revision is one in which primary implants are feasible due to adequate bone stock.
Figure 1. This patient had had prostate cancer a number of years before. He had a fall many years later and an uncemented bipolar prosthesis was placed. The hip became painful as the ball of the hip began eroding into the acetabulum and caused pain. The hip was revised and an allograft used to build bone stock which had been lost due to radiation.
Figure 2. When a prosthesis runs its course bone is lost due to osteolysis where the small generated particles cause the immune cells to be activated and actually destroy bone. These are challenging cases to revise due to the lack of bone on wchich to mount the endoprostheses.
Figure 3. A fairly uncommon but significant complication of hip replacement surgeries, foot drops do cause problems in ambulation. In this case the painful hip prosthesis was revised and a tendon transfer was done at the same time.
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