ICJR CASES: Managing the Complications of THA

    Despite advances in technology for performing total hip arthroplasty (THA), despite surgeons’ efforts to mitigate their patients’ risk factors, complications will develop postoperatively, especially in more complex patients.

    Moderator Gregory G. Polkowski II, MD, MSc, demonstrated this reality during a session on avoiding and managing complications of THA at ICJR’s Inaugural Emerging Technologies in Joint Replacement course. He presented 5 difficult cases and asked a panel of experienced orthopaedic surgeons to discuss how they would handle these patients.

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    Panel members included:

    • Jeffrey T. Hodrick, MD
    • Scott M. Sporer, MD, MS
    • Preetesh D. Patel, MD
    • Arthur L. Malkani, MD
    • Michael J. Christie, MD

    Here are the cases Dr. Polkowski shared with the panel:

    Case 1: 48-Year-Old Male Patient

    • Right groin/lateral hip pain for the past 3 years
    • Had undergone lumbar arthrodesis for back pain
    • Physical therapy and corticosteroid injections provided some pain relief
    • MRI of the hip shows osteoarthritis
    • Underwent THA at another facility
    • Underwent closed reduction in the emergency department twice after anterior dislocation of the hip within 3 months of THA

    Case 2: 63-Year-Old Female Patient

    • Underwent THA on the right hip for osteoarthritis at another facility
    • Has had persistent pain in the 18 months since surgery
    • Elevated erythrocyte sedimentation rate, C-reactive protein, and nucleated cell count

    Case 3: 57-Year-Old Male Patient

    • 3 years post-THA of the right hip with a metal-on-metal implant at another facility
    • Experiencing lateral pain
    • Normal erythrocyte sedimentation rate and C-reactive protein
    • Slightly elevated cobalt and chromium levels

    Case 4: 68-Year-Old Male Patient

    • 2 years post-THA of the right hip for osteoarthritis at another facility
    • Experiencing right hip and thigh pain; start-up pain
    • Seeking a second opinion
    • Radiographs show radiolucent lines around the femoral component

    Case 5: 78-Year-Old Male Patient

    • Right femoral neck fracture and posterior acetabular wall fracture sustained in a motor vehicle collision
    • Underwent open reduction and internal fixation of the acetabulum and then a cementless THA
    • Falls again less than 4 months later, sustaining a periprosthetic fracture

    Click the image above to watch the presentation and find out how these cases were resolved.