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 or, D Dept. t. o of Biomed edica cal E Enginee neering ng Univer ersity ty o of Tennes nnessee ee Assista tant C nt Clini nical cal P Profes essor or, D Dept. t. o of Orthop hoped edic S c Surger ery Univer ersity ty o of Color orad ado H Health S th Scienc ences es C Center nter Clini nical cal D Director ector Rocky M Mtn. n. M Muscul culos oskel eleta etal R Resear earch L h Labor orator tory Denver er, C Color orad ado

CASE 1 SE 1

MVA → Fx  1989 89 M Fx-Dis Dislo locatio tion L Left t Hip ip • ORI RIF / / Age Age 2 29 Ye Years c OA → THA  1997 97 / / Adva vance ced T Trau aumat atic 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 Ring 1 Ri 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 o Do Now??? • New C Const strained ed Line Li 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 o 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

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…. Center for Joint Preservation & Reconstruction

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

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… Center for Joint Preservation & Reconstruction

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 oach? h?  Nerve ve P Palsy R sy Rat ate e ?  What A Anatomi omic 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 ocha hant nter Positio itioned Poste terio iorly ly

 9 Years Postop  Normal Gait