THA THA CA CASES Do Douglas A s A. De . Dennis is, M.D M.D. - - PowerPoint PPT Presentation

THA THA CA CASES

Do Douglas A s A. De . Dennis is, M.D M.D.

Adjunc unct P t Profes essor

• r, D

Dept.

• t. o
• f Biomed

edica cal E Enginee neering ng Univer ersity ty o

• f Tennes

nnessee ee Assista tant C nt Clini nical cal P Profes essor

• r, D

Dept.

• t. o
• f Orthop

hoped edic S c Surger ery Univer ersity ty o

• f Color
• rad

ado H Health S th Scienc ences es C Center nter Clini nical cal D Director ector Rocky M Mtn.

• n. M

Muscul culos

• skel

eleta etal R Resear earch L h Labor

• rator

tory Denver er, C Color

• rad

ado

CASE 1 SE 1

1989

89 M MVA → Fx Fx-Dis Dislo locatio tion L Left t Hip ip

• ORI

RIF / / Age Age 2 29 Ye Years

1997

97 / / Adva vance ced T Trau aumat atic c OA → THA THA

• Mu

Mult ltip iple D Dis islo locatio tions

• Revi

visi sion T THA 1 1998 998 / / Const strained ed L Liner

Dis

islo locatio ion Wit With D Dis isplacement Of t Of L Lockin ing Ri Ring 1 g 12/01

• Revi

vised sed W With New Const strained ed L Liner 12/ 12/01

Redisl

slocated ed 2/0 /02 An And Re Referred To To Me

32mm Head / +17mm Neck With Skirt 10º / Constrained Liner Multiple THA Dislocations

What

hat To Do Now

• Do Now???
• New C

Const strained ed Li Line ner?

• Acet

cetabular ar R Revi visi sion?

• Femoral

al R Revi visi sion?

• Ski

kirt rted Ne Neck?

• Surgica

cal A Approac ach?

• Se

Send nd T To

• My Pa

Partner?

36mm Head / +12mm Neck (No Skirt) 10º / +4mm Extended Lip Liner Greater Trochanteric Advancement No Further Dislocations @ 9 Years

CASE 2 SE 2

Center for Joint Preservation & Reconstruction

2017 OSET Hip Cases

Matthew Hepinstall, MD

Associate Director, Lenox Hill Center for Joint Preservation & Reconstruction Assistant Professor, Zucker School of Medicine at Hofstra Northwell

Center for Joint Preservation & Reconstruction

Case 2 68 year old female Primary right THR at OSH complicated by femoral subsidence Implant integrated so underwent head exchange for LLD Now recurrent posterior dislocator

Center for Joint Preservation & Reconstruction

Case 2 Stiff spine Cup anteversion is 31° Stem anteversion is 4° No bigger head allowed in cup Already has posterior elevated rim poly

Center for Joint Preservation & Reconstruction

Case 2 Femoral revision Improved head-neck ratio, femoral version and leg length Osteotomy to remove stem may help trigger robust scar response No dislocations x 9 months….

CASE 3 SE 3

52

2 Yr Yr Female

Dis

isablin ling L L Hip Hip P Pain in

NSA

SAIDS / DS / Inject ction

Sin

ingle le C Cru rutch

Cl

Clei eidocr cranial Dy Dysplasia

• Dx

Dx In C In Chi hildhood

Se

Sever ere Co Coxa Vara

• Bilate

ateral V Valgus Osteo teotomies @ @ Age 1 11

Sugges

este ted T Treatm tmen ent t & Pr Preop Ev Evaluati tion

CT: 3 : 3-D IMA IMAGES

Late teral V l Vie iew Transve sverse se P Plane e

3-D I IMAG MAGES

THA THA WI WITH TH O OSTEO STEOTOMY

How T

To Execu cute I te Intraop aoperativ ratively ely ? ??

Fi Figur gure 3A e 3A

PO POSTO STOP

CASE 4 SE 4

Center for Joint Preservation & Reconstruction

Case 4 60 yo female h/o 3 R THA dislocations 1 L THA dislocation

Center for Joint Preservation & Reconstruction

Case 4 Stiff spine

Center for Joint Preservation & Reconstruction

Case 4 8 degrees acetabular anteversion 14 degrees femoral anteversion

Center for Joint Preservation & Reconstruction

Case 4 Cup revision 2015 Increased anteversion Dual mobility

Center for Joint Preservation & Reconstruction

Case 4 One year post op Doing great overall 120 degrees flexion 20 degrees IR 65-70 degrees ER 70 degrees abd 20 degrees add Occasional click

Center for Joint Preservation & Reconstruction

Case 4 One year post op Doing great overall 120 degrees flexion 20 degrees IR 65-70 degrees ER 70 degrees abd 20 degrees add Occasional click

Center for Joint Preservation & Reconstruction

Case 4 One year post op Doing great overall 120 degrees flexion 20 degrees IR 65-70 degrees ER 70 degrees abd 20 degrees add Occasional click

Center for Joint Preservation & Reconstruction

Case 4 15 months post-op

Still only occasional clicks Normal MARS MRI Cobalt 9.1 Chromium 0.5

25 months post-op

Still only occasional clicks Cobalt decreasing but not normal Chromium 0.5 Repeating MARS MRI…

What now? Revise? Wait?

Center for Joint Preservation & Reconstruction

Dual mobility has proven a very helpful tool. I still use it! Ain’t nothing free. Variation in dual mobility articulations may influence jump distance, impingement-free ROM and notching risk…

CASE 5 SE 5

54

4 Yea ear F Female With th Di Disabling g Right H Hip Pa Pain

2.5 I

5 Inch LLD / D / No O Oth ther er Co Conge genital al A Anomalies

WHA WHAT TO TO DO DO NO NOW? W??

Which S

h Surgic ical A Approa

• ach?

h?

Nerve

ve P Palsy R sy Rat ate e ?

What A

Anatomi

• mic V

Varia ianc nces?

Prost

sthes esis C s Consi siderations

Hi

Hip Re p Reduction Tri Tricks

Acet

cetabular ar B Bone e Defici cien ency cy Op Optio ions

DDH DDH: FEMOR MORAL A L ANATOMI MIC C VA VARIANCE CES

↑ Fe

Femor moral Anteve eversion

• 60

60-80 80º º

 Gr. T

Troc

• cha

hant nter Positio itioned Poste terio iorly ly

• 9 Years Postop
• Normal Gait