ICJR CASES: Managing Revision Total Hip Arthroplasty Patients

    A patient who underwent staged bilateral total hip arthroplasty (THA) 10 years earlier with metal-on-metal implants presents for a second opinion. She’s had increasing pain in both hips, left worse than right, for about a year. Her formerly low cobalt and chromium levels are now markedly increased, and imaging shows massive soft tissue collection around both hips.

    She clearly needs a revision THA. What would be your plan for this procedure? Now, factor in that her body mass index (BMI) is 50 and that she has a history of bilateral deep vein thrombosis (DVT). How does that change your thought process?

    RELATED: Register for the 7th Annual Revision Hip & Knee Course

    This is 1 of 4 cases presented by Mark W. Pagnano, MD, from Mayo Clinic, Rochester, Minnesota, during a panel discussion on revision THA at the ICJR East ISK Hip & Knee Course. Panel members included Michael P. Bolognesi, MD; Richard Iorio, MD; and Ran Schwarzkopf, MD, MSc, and during the session, they discussed how they would manage the following cases:

    Case 1

    • Male patient who underwent staged bilateral THA in 1991, with revisions for polyethylene wear, acetabular loosening, and osteolysis in 1997 (right hip) and 1999 (left hip)
    • Patient fell in 2015; no fracture
    • Patient presents in 2017 with progressively increasing hip pain that interferes with activities of daily living

    Case 2

    • 74-year-old female patient who underwent staged bilateral THA in 2007 with metal-on-metal implants
    • Asymptomatic, but has undergone intermittent chromium and cobalt level testing since 2010
    • Developed bilateral deep vein thrombosis requiring stenting of her left external iliac and femoral veins
    • Patient presents with a 1-year history of bilateral hip pain, left greater than right

    Case 3

    • 54-year-old male patient with trisomy 21 and dementia
    • Complained of right hip pain after an unwitnessed fall
    • Previously able to ambulate, but refused to walk after the fall
    • Diagnosed with displaced femoral neck fracture and undergoes primary THA

    Case 4

    • 69-year-old male patient who underwent right THA in 1999 and left THA in 2001
    • Patient presents with worsening groin pain and no history of trauma
    • Imaging shows massive lysis around both sockets

    Click the image above to watch the presentation and find out what the expert panel members had to say about these cases and how the cases were resolved.