Patient is a 50 year old male who came in 2012 complaining of left hip pain. Prior to this visit the patient had a left hip replacement in 2011, performed by Orthopedic Surgeons at another facility. Patient had come in complaining of severe pain, which he felt had been increasing since his surgery.

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Four views were taken: AP Pelvis (top left), Left AP Hip (top right), Left Lateral Frog (bottom left), Right Lateral Frog (bottom right)

X-rays revealosteolysis in the acetabulum with possible loosening of the femoral component. Loosening is best seen on comparison with earlier X-ray.

Options were discussed with the patient along with the increased risks that can be associated with revision hip surgery. A few of the risks discussed consisted of, but are not limited to, infection, deep various thrombosis, stiffness, loosening of the implant, persistent worsening of pain, nerve or vascular injury, healing possibly requiring transfusion, loss of sensation, instability, and mortality.

We requested for earlier operative reports while the patient was advised to get an aspiration of the left hip to test for cell count with differential, culture, and sensitivity – aerobic, anaerobic and acid fast. The patient was also informed to not take any antibiotics for at least 2 weeks before getting the aspiration. Patient was also advised to obtain a left hip CT scan and obtain metabolic bone labs which included 25-hydroxy Vitamin D. The patient then followed up to review the results of the tests.

Aspiration had indicated that the patient was positive with MRSA in his nares and had an infected D/T joint prosthesis. Results also revealed that the patient had a high ESR and a high cell count. The patient was informed that the best approach for him would be a staged reconstruction, which the patient had chosen to proceed with.

The Left Hip THA was performed in 2012.

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X-Ray of Left Hip during operation

The patient followed-up 6 weeks after his spacer spacer placement surgery and brought new X-rays to review. At this point, post-op, the patient’s scar had healed well and he had moderately restricted range of motion.The patient was advised to get a left hip aspiration and to follow up with the results. He also was instructed to continue antibiotics per ID and to stop 2 weeks prior to aspiration.

Upon follow up, revision surgery was discussed with the patient as well as all of the risks, benefits, and any alternative options.The patient understood the underlying risks associated, including, but not limited to, the ones previously stated.

The Removal of Spacer and Revision of Left Hip THA was performed in 2013.

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X-Rays of Left Hip during operation

X-Rays show intraoperative changes including placement of long stem THA, 2 screws setting the acetabulum, and cerclage wires surrounding the femur. X-Rays also show anextended trochanteric osteolisi of theproximal one-third femoral shaft that is secured with cerclage wires.

The patient followed-up about 4 weeks post Removal of Spacer and Revision Left THA with new X-rays to review. The patient presented with a moderate restriction of his range of motion, decreased strength, and atrophy. He was advised to continue taking Aspirin 325mg two times a day, Vitamin D3 5,000 IU daily, and to follow up in 6 weeks with new X-rays to monitor progression post-operatively.

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At follow-up patient was feeling good relief and was pain free. Upon examination,he hadno tenderness over the greater trochanter of both the lower left and lower right extremities. At subsequent follow-ups the X-rays reviewed were normal and showed that there was no acute displaced fracture.

The patient was advised to begin weight bearing as toleratedand continue Vitamin D3 5,000 IU daily. Patient then came in 6 weeks later for a follow-up and presented with minimal stiffness. He was instructed to continue previous treatment plan including continue the Vitamin D3 5,000 IU daily and weight bearing as tolerated. Patient has done very well subsequently.

*Patient identifiers and dates changed to protect patient privacy.

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