Challenging the Experts: How Would You Handle These Complex Primary THAs?

    Most primary total hip arthroplasty (THA) cases are straightforward and lead to very successful outcomes.

    Then there are the patients who present with complicating factors that challenge a surgeon’s knowledge and skills. With good preoperative planning, these can still be quite successful procedures that relieve pain and restore a patient’s function.

    At ICJR’s Transatlantic Orthopaedic Congress last fall, moderator David J.Mayman, MD, challenged an expert panel to view the radiographs of 3 difficult THA cases he had encountered, listen to the history and physical findings, and then share their thoughts on how they would manage the patients. The panel includes Thomas K. Donaldson, MD; Mark W. Pangnano, MD; Wayne G. Paprosky, MD. B. Willem Schreurs, MD, PhD; and Jonathan Vigdorchik, MD.

    Here are the basics of the cases they reviewed:

    Case 1

    • 58-year-old male, a police chief from upstate New York
    • Height: 5 feet 8 inches; BMI: 35
    • Traumatic injury to his right femur 20 years prior, repaired with open reduction internal fixation (ORIF)
    • Well-healed lateral incision from the ORIF
    • Ambulates with coxalgic gait
    • Hip range of motion 0° to 95°
    • Painful flexion and internal rotation

    Case 2

    • 56-year-old male involved in a motorcycle accident 1 year prior
    • Spent 30 days in the intensive care unit after the accident
    • Right acetabular fracture repaired with ORIF
    • Left tibial plateau fracture repaired with ORIF, complicated by a methicillin-resistant Staphylococcus aureus infection; no history of infection at the right hip fracture
    • Right arm brachial plexus injury with multiple fractures
    • Left ankle fracture
    • Neurologically intact
    • Ambulates with a severely coxalgic gait

    Case 3

    • 38-year-old male with Perthes disease
    • Underwent a left hip fusion and subtrochanteric osteotomy at age 16
    • Presents with bilateral hip pain, low back pain, and contralateral knee pain; the right, non-fused hip and the low back cause the most pain
    • Ambulates with a severe limp
    • Left leg is 3 inches shorter than the right leg

    Click the image above to find out what the experts had to say during this case-based panel discussion.