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.
Dr Shekhar Agarwal
Revision Total Hip Replacement
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.
Re-Revision Complex Total Hip Replacement
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.
Valgus Knees – Total Knee Replacement
60 years old lady came with complaints of pain in both knees and valgus deformity. She had past history of operation around both knees in her childhood for deformity correction. Pre-op x-rays shows arthritic knee with severe valgus deformities. Thus she planned for Total Knee Replacement staged wise due to obesity and diabetes. This procedure requires special planning and implants.
Patient underwent Right Total Knee Replacement with stem tibial component, augmentation of tibial defects with screws and patella resurfacing.
Now patient is comfortable and walking with walker.
Dysplastic Hip Uncemented-Total-Hip-Replacement
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.