CASE 23: Complex primary hip replacement after surgery for hip dysplasia in a mid-life woman, using a primary hip stem
The Story
“The patient is a 53-year-old female patient who presented with left hip pain.
She was diagnosed with developmental dysplasia of the hip at the age of 18 months, and had an osteotomy to correct for this. At 26 she had removal of this metal work.
She had also been diagnosed with scoliosis and had metalwork implanted at the age of 13.”
The Investigation
On examination in clinic, this patient used a walking stick and left shoe raise. Her left hip movements were very painful and restricted. She had a 5cm leg length discrepancy, with the left being shorter.
The Evidence
Anteroposterior plain radiograph of the patient’s pelvis shows end stage osteoarthritis in the left hip and deformity of the femoral head. The acetabular socket is in the correct place.
The Diagnosis
End stage osteoarthritis of the left hip, developmental dysplasia of the left hip and a significant leg length discrepancy of 5cm requiring a primary total hip replacement.
The Plan
This patient had a CT scan and an EOS scan to help plan her primary total hip replacement.
The Operation
Key Surgical Steps:
A posterior approach was used. A 50mm socket was inserted with one screw and polyethylene liner.
A cemented C stem was used with a 32mm head. The leg length and joint stability was checked.
The bony exostosis was removed and no impingement was present.
The wound was washed and closed with Vicryl and Monocryl
The Outcome
Anteroposterior plain radiograph of the patient with a cemented C stem femoral component and a press-fit Gription Pinnacle cup with a single iliac screw.
A pre and post-op comparison EOS image. EOS imaging is a standing biplaner radiography system that can take full body low dose radiographs in functional positions. This can be used to assess leg length discrepancy.
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The patient is very happy with her leg lengths and has not walked so normally for 30 years.
The Verdict
“EOS imaging is a standing, low radiation dose and bi-planer (AP and Lateral taken simulataneously) radiography system that takes full body radiographs in functional positions (standing and sitting).
EOS can be used for pre-operative planning to avoid post-operative: 1) leg length inequality and 2) impingement and dislocation.
This patient was at risk of both leg length inequality and impingement. These were avoided by using EOS.”
