HOW I DO IT PAGE
Case 1:
This 42 years old hawker sustained a Fracture Neck Of Femur
following a Motor Vehicle accident 3 years earlier. He had internal
fixation with cancellous screws done for the Neck Of Femur at another
Hospital.
He saw me
about 18 months after the 1st operation with a non union of the
fracture. The neck had collapsed and the screws backed out but
had not broken. I did a valgus with Trochantric osteotomy and
used the DHS and a canulated screw for fixation.
I also harvested
autograft from the ipsilateral fibula harvesting longitudinally
but having the rest of the fibula intact,.This
autograft was put in the hole drilled for the DHS screw and the
canulated screw. The screws was than passed beside the graft.
The fixation of the screw was very tight since the 
graft
acted as a filler. I would recommend using autograft as a filler
to enchance screw fixation in cancellous bone, if the bone is
too soft. Unfortunately this hip underwent osteonecrosis 1 year
later.
He however
complains only of a mild discomfort. I have decided to wait since
he is able to carry working as a hawker. He does not need any
analgesic for now since he has already had 1 osteotomy . My plan
for further surgery would be a THR.
since the osteotomy was above the lesser trochanter, during a
THR the femoral component can be passed down easily into the medullary
canal. If the osteotomy was below the lesser trochanter the you
would proably need to reosteomy the old osteotomy to pass the
femoral component down.
| 1 |
Dislocate
the hip and then remove the implants ,to prevent a possible
femoral fracture from happening.
|
| 2 |
when
reaming the medullary canal, the proximal part of the canal
may be stenotic along where the implants were i may need
a powered reamer for this part of the canal.
|
| 3 |
Sound
the medullary canal with a curete it is very easy to exit
the canal laterally when reaming.
|
| 4 |
before
cementing the canal use the first mix of cement to occlude
the lateral holes made by the DHS implant. the second mix
of cement is then loaded in tyhe gun and the cement can
then be pressurised in the canal There is no need to look
and occlude the medial holes on the femur since fibrous
tissue would have occluded these holes.
|
Case
2: WKK is a 54 yrs old female
of average build. She had a bilatual THR done 18 
yrs
ago for a DDH at another institution. 3 yrs ago she had a revision
on the right as seen on the x-ray. This hip is now asymptomatic.
She now has pain on the left side. This pain is severe. She also
experiences night pain and pain when she walks.
X-Ray Shows:
1 |
That
the cup was set in the right hip centre position, probably
where the bone stock was best.
|
2 |
I
measured the head it is a 32mm.NB it has lasted 18 yrs.
Knowing the head size it would give a reference of magnification
for all other measurements on the x-ray.
|
3 |
On
x-ray the cup is loose.
|
4 |
There is a thick cement mantle on the proximal femur. There
does not seen to be a good cement mantle distally but this
stem has lated 18 yrs and I think it is not loose. |
She needs
a revision. Can you suggest what to do.
QUESTIONS:
1. Exposure.
2. Choice of revision implants.
3. Would you revise one or both components.
4. What would be the location of the cup.
5. Would you bring the cup down or choose the high hip centre.
View Answers
Answer Here
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