Case Study: Complex Hip replacement – Implant removal with total hip replacement
A 53 year-old gentleman who unfortunately developed arthritic change in his right hip at a relatively young age. He was seen by an orthopaedic surgeon at a different institution approximately 10 years prior to him being seen by myself, and he was advised that a hip resurfacing would be the best surgical option for him. He subsequently underwent this procedure along with a redirectional osteotomy, and had a period of approximately 5-6 years free from hip pain following his recovery.
During the 2-3 years prior to his visit to our clinic, he had been experiencing increased levels of stiffness and pain in his right hip to the point where his gait was significantly affected – indeed it was this factor that prompted him to seek further medical attention for his hip. Despite this, he remained as active as possible, taking medications only for blood pressure and high cholesterol and having no known medication allergies. He also does not smoke.
Physical examination revealed essentially no passive or active range of motion in his right hip, his left hip examination was unremarkable, as was examination of his knees.
Plain film radiographs revealed the reason for his pain and lack of range of motion – he had developed extensive heterotopic ossification around his resurfaced hip to the point where his body had essentially fused its own hip – also known as ankylosis.
We discussed Mr. LR’s condition with him, and advised that should he wish to pursue surgery, we would perform a “take-down” of his fusion and revise his resurfacing to a Total Hip Arthroplasty.
He agreed, and as such we performed revision surgery on his right hip. We used the same approach as the previous surgeon had used – in this case a lateral approach. We encountered significant amounts of heterotopic bone during our dissection which we carefully and meticulously removed. We eventually found the femoral resurfacing component within the large area of ossification and removed it, along with enough bone to allow for restoration of a comfortable range of motion.
We then identified the all-polyethylene acetabular component buried deep in the surgical field. We removed it by carefully chipping away at the cement holding it in position before finally removing all cement remnants once the component had been extracted.
We then prepared both the femur and acetabulum for our revision components, and placed them in position without event. We ended the procedure with a stable hip with good range of motion.
3 months post-op, Mr. LR had regained most of his strength in his hip, and is ambulating pain-free and back at work.