Patient is an 80 year old male who has a history of prostate cancer, hypertension, and spinal stenosis. Patient had first come in early 2013 complaining of right hip pain that he had been experiencing for a few years. He stated that he had previously tried physical therapy along with pain medication but has felt minimal relief.
Upon examination, the patient presented with tenderness and a severely restricted range of motion. Patient had explained that he had severe groin pain, had difficulty with daily activities, and had to lift up his leg to get into his car.
Upon review, X-rays showed that the patient had right hip arthritis, as shown below. Options were thoroughly discussed with the patient along with the risk, benefits, and any alternatives, but it was advised that the patient receive a Right Total Hip Arthroplasty (THA) due to his present signs and symptoms.
The patient had decided to have a right THA. Due to his history of cancer, it was discussed at length with the patient that he was at a higher risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).
X-Rays show arthritis of the left and right hip joints with worse findings in the right hip joint
X-Rays show right total hip arthroplasty with good positioning of prosthesis
Patient followed-up a few months post-operatively and presented with tenderness over the left greater trochanter due to bursitis. Since the pain was a symptom of the bursitis and not from joint arthritis, the patient did not need a THA, and instead was given an injection, which gave him good relief. Upon subsequent follow-ups the patient was doing well post-operatively, however he began to complain of mild left hip pain.
Upon examination and review of X-rays, it was determined that the patient had severe left hip osteoarthritis (OA). Options were discussed with the patient including a possible left THA. The patient was informed that although X-Rays indicate severe OA, the surgery is not yet indicated because he is only experiencing pain from the bursitis.
It was explained that the patient is treated as per how the patient presents, not what the X-Rays show – if there is no severe pain from the joint then surgery is not yet advised.
X-Rays show osteoarthritic degeneration of the left hip
*Patient identifiers and dates changed to protect patient privacy.
