Case Study

Complex hip replacement – Hip replacement with prior hardware in position in a 71 year old female

A 71 year-old lady who had surgery for a fractured femur 8 years prior to visiting our clinic. She had a long metal rod placed in her femur and had gone on to heal her femur fracture, but unfortunately also develop hip arthritis. Her arthritis was advanced and quite debilitating, she had been forced to rely heavily on her cane for mobility for many months and had hip pain that had proved refractory to all pain medications and modalities.

Her medical history was significant for previous cardiac issues, osteoporosis, age-related macular degeneration and stress incontinence. She took numerous cardiac medications, including a blood-thinning medication. She has an allergy to sulfa-containing medications.

Her X-rays revealed her previous surgical hardware and a healed femur fracture with a small malunion in her femoral canal. Her hip was severely arthritic, with almost no joint space visible at all.

We counselled her that she clearly required a Total Hip Replacement, but that she would also need to have her femur fracture hardware removed in order for us to be able to perform a Total Hip Replacement. We explained to her that we would be able to do both procedures under the same anaesthetic, albeit taking slightly longer than a normal Total Hip Replacement. She agreed to this course of treatment.

During her surgery, we first identified the insertion sites of the various components of her femur fracture hardware, and removed these carefully in the appropriate sequence. Once they were fully removed, we then began the hip replacement part of the procedure. Her acetabular component was placed without event, her femoral component proved more challenging to prepare for, given the new bone her body had formed in the area of the fracture. With careful removal of the bone blocking the femoral canal, we managed to implant a special femoral component that bypassed the site of the fracture, significantly reducing the risk of her femur fracturing again in the same area.

Mrs. NT’s recovery was prolonged due to her being deconditioned after suffering from arthritis for so long, and she did require admission to a rehabilitation facility. However, her progress here was excellent and 1 year post-op she is ambulating without a gait aid and pain-free.

Pre-op

Complex hip replacement - Hip replacement with prior hardware in position in a 71 year old femalea

Post-op

Complex Hip replacement – Implant removal with total hip replacementb

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