Insights on Managing Complex Total Hip Arthroplasty Cases

    At Essential Hip Topics: Cradle to Grave – a pre-course to the Mid-America Orthopaedic Association (MAOA) annual meeting organized by MAOA and ICJR – moderator Ronald E. Delanois, MD, challenged an expert panel to view the radiographs of 6 complex total hip arthroplasty (THA) patients, listen to the history and physical findings, and then share their thoughts on how they would manage the patients.

    The panel included C. Lowry Barnes, MD; Michael A. Charters, MD; Trevor G. Murray, MD; Ryan M. Nunley, MD; and Robert T. Trousdale, MD. Here are the basics of the cases they reviewed:

    Case 1

    • 47-year-old female
    • Chronic left hip pain limiting her activities
    • History of dysplastic hip
    • Significant surgical history
      • Left hip reductions at age 1 and 2
      • Left femoral rotational osteotomy
      • Acetabuloplasty
      • Chiari osteotomy

    Case 2

    • 88-year-old male
    • Right THA in 1991
    • Increasing right hip/groin pain with an inability to ambulate
    • Had stepped out of the shower and felt a “pop,” which precipitated pain
    • Physical exam: Right hip pain with range of motion, neurologically intact

    Case 3

    • 80-year-old male
    • Left THA in 2010
    • Deep pain in the left hip, affecting the buttock and lateral hip, for the past year
    • Multiple injections in the left hip bursa to relieve pain; no improvement reported
    • Antalegic gait, Trendelenberg to the left
    • Soft mass in left hip
    • Pain with resisted abduction and hip flexion
    • Hip flexion 90, full extension, internal rotation 5, external rotation 10, abduction 25, adduction 10

    Case 4

    • 83-year-old female
    • Left hip pain after a fall
    • Hospitalized for 29 days with hypertensive urgency, urinary tract infection, and newly diagnosed dementia
    • Left THA in approximately 2007; no complications since then

    Case 5

    • 70-year-old female
    • Left THA in early 2018
    • Presents with left hip pain after a mechanical fall from standing height
    • Unable to bear weight after the fall

    Case 6

    • 62-year-old male
    • Unbearable pain in the left groin and lateral hip for the past 6 months
    • Involved in a motor vehicle crash at age 23; fractures of the femur, pelvis, and humerus
    • Failed open reduction internal fixation of the femur fracture converted to THA 1 year later
    • 2 revision THAs: 10 years after the conversion to THA and again in 1999

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