Case of The Week

Conversion Total Hip Replacement

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47 years old gentleman presented with complaints of pain in left hip and inability to bear weight over left lower limb.  There was shortening of left limb of about 4 cm. Patient had history of residual post-polio paralysis of left upper limb and left lower limb but patient used to walk without support. He had sustained fracture of the left hip 6 month ago which was fixed with screws.   Pre-op x-ray showed ununited fracture neck of femur with failed osteosynthesis. Thus patient was planned for hip replacement to overcome the limb length discrepancy and non-union neck of femur. As patient had post polio residual paralysis dual mobility hip replacement surgery was done to enhance the stability of hip joint. Post operative x-ray showed dual mobility hip replacement. Now patient is walking comfortably with walker and leg shortening has been corrected.

Conversion Total Hip Replacement

Revision Total Hip Replacement (THR)

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72 years old lady presented with complaints of pain in right hip and difficulty in walking for the last 6 months. She had undergone partial hip replacement (Hemiarthroplasty) 16 years ago.

There was no evidence of infection. The leg was short by 3 cm due to sinking of the previous implant in the femur. Preoperative X-ray showed loosening of femoral prosthesis. We planned for conversion to Total Hip Replacement. These cases require special surgical skills to remove the previous prosthesis without bone loss and special implants to get good fit in residual bone. As the patient had good bone stock we used uncemented total hip implants. Now patient is comfortable and the shortening of the leg has also been corrected.

Revision Total Hip Replacement (THR)

Revision Total Hip Replacement

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55 years old lady came to us with complaints of pain in right hip with shortening of 5 cm. She had a hip replacement 40 years back which had failed. She was barely managing with a walking stick till now. She had severe pain for the last 6 months. We performed Total Hip Replacement. The acetabulum bone was inadequate which had to be supported with a special implant called Mueller’s Ring into which a poly cup was cemented. The shortening was also corrected and she now has a pain free stable hip.

Revision Total Hip Replacement

Re-Revision Total Hip Replacement

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3D Bone Model made before surgey to identify acetabular bone defect55 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.

Re-Revision Total Hip Replacement X-Ray

What is Total Hip Replacement?

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Total Hip Replacement is one of the most successful operations for people who suffer from extreme pain in their hip joint. You may have likely already tried alternative treatment such as pain medicine, bone supplements and physiotherapy.

If you have decided that you need this operation, here at Delhi Institute of Trauma & Orthopedics, we are committed to making your recovery a comfortable and successful one. Furthermore, improvements in the design of hip implants and development of newer and less invasive surgical techniques improve recovery time.

The results of this operation can vary depending upon your pre existing medical conditions such as diabetes, your overall health, obesity and type of ailment that you may have.

Hip Replacement

The hip joint is one of the largest weight bearing joints of the body. Most of our activities like walking, jumping, sitting, squatting, dancing, swimming, climbing etc. depend on our hip as it provides mobility along with stability. In routine life our hip moves millions of times to perform the above activities without even knowing.

 

However, once it is damaged not only does the hip become stiff, we also start to walk with a painful limp and every step needs considerable effort, restricting our activities significantly. It is only then that we come to realize how much freedom of movement means to us.

Replacement of hip joint is a well established and a very successful operation for the last 50 years in which the diseased hip joint is replaced with an artificial hip joint.

It not only provides you freedom from pain, and stiffness, but also improves the quality of life. This specialized operation is now very successful and has been accepted very well both by the medical fraternity and society.

This handbook aims at providing you information about Total Hip Replacement surgery. It discusses in brief the various issues related to the surgery and its after care helping you prepare for this operation.