Total Hip replacement(2 stage revision): Combined intra-pelvic and extended trochanteric osteotomy approach
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The old adage, ‘You don’t want to start from here,’ rings true for many revision cases, especially when you work in a tertiary referral centre.
This case details the thought processes and techniques around the first stage revision of an infected and ‘intra-pelvic’ hip , an extreme revision scenario.
In this case the patient had earlier received a primary hip replacement which was revised for ‘aseptic loosening’. This revision entailed bony reconstruction with a metal augment. Unfortunately this revision became infected. The patient did not want further surgery and was coping well on suppressive antibiotics, until they were ceased.
In addition to the usual work-up, patients with an intra-pelvic hip require imaging to specifically identify the location of the important non-orthopaedic structures , in this case the large vessels and the ureters. Vascular and general surgical assistance is required.
The principles of a thorough and controlled debridement is covered in this case as well as an Extended Trochanteric Osteotomy. The second stage hip replacement (with a custom 3D printed implant) will be covered in a subsequent technique (once infection eradication has been confirmed).
Prosthetic joint infection is miserable condition and there is evidence that it is an increasing problem. The cost to society of revising an infected revision more than double that of a non-infected revision. (Total hip arthroplasty revision due to infection; A cost analysis approach. Kouche et al Orthopaedics and Traumatology Surgery & Research 2010).
The cost to the patient is often overlooked but it is not unsurprising that patients with infected joints have poor mental health outcomes. Imagine having a chronically painful joint replacement, the prospect of at least one more significant operation, an 8% chance of revision failure and at best having poorer function than primary surgery.
Author: Mr Andrew Gordon PhD ,FRCS (Tr & Orth)
Institution : The Northern General Hospital ,Sheffield ,UK.
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Question 1 of 15
Which one of the following answers regarding a 3 phase bone scan is correct ?CorrectIncorrect
Question 2 of 15
Regarding prosthetic joint infection, which one of the following would be considered positive for infection?CorrectIncorrect
Question 3 of 15
Regarding overall revision rates after primary hip replacement (expressed as numbers per 1,000 patient-years) which one answer is correct.?CorrectIncorrect
Question 4 of 15
Which one answer is correct? The following antibiotic should not be added to PMMA bone cement?CorrectIncorrect
Question 5 of 15
Which one of the following answers is correct? Regarding acetabular bone loss, a Paprosky Type 2C defect is classified as having…CorrectIncorrect
Question 6 of 15
Which one answer regarding the saw blade in an ETO is correct?CorrectIncorrect
Question 7 of 15
Regarding the contents of the Greater Sciatic Notch, which one statement is correct?CorrectIncorrect
Question 8 of 15
Regarding PMMA cement which one of the following questions is correct?CorrectIncorrect
Question 9 of 15
Which one of the following is correct regarding post-operative monitoring of complex revision patients ?CorrectIncorrect
Question 10 of 15
Regarding Gram staining which one of the following statements is correct?CorrectIncorrect
Question 11 of 15
Regarding absolute contra-indications for a single stage revision for infection, which one statement is correct?CorrectIncorrect
Question 12 of 15
Regarding the sciatic nerve, which one statement is correct ?CorrectIncorrect
Question 13 of 15
Regarding a standard Extended Trochanteric Osteotomy, which one statement is correct?CorrectIncorrect
Question 14 of 15
Regarding the Iliac Arteries, which one statement is correct?CorrectIncorrect
Question 15 of 15
Regarding microbiological sampling and culture, which one statement is incorrect?CorrectIncorrect