Tips, Tricks, and Techniques for Revision THA

    With the number of revision total hip arthroplasty (THA) procedures projected to increase significantly in the next 2 decades, joint replacement surgeons need to be prepared for these potentially challenging patients.

    Charles L. Nelson, MD, from the University of Pennsylvania in Philadelphia, is at the forefront of educating surgeons as the chair of ICJR’s Revision Hip & Knee Course, and in a session at the recent Combined OrthoLIVE/MTJR meeting, he shared his expertise in series of video vignettes highlighting various aspects of 4 difficult revision THA procedures.

    In the first – and longest – vignette, Dr. Nelson operates on a patient who presented with worsening hip pain and suspected infection. Her erythrocyte sedimentation rate and C-reactive protein level were found to be elevated, and aspiration of the hip confirmed a periprosthetic infection.

    X-rays show significant superior bone loss. They also show a small femoral canal that will not accommodate a regular, long PROSTALAC implant.

    Because of that, Dr. Nelson decides not to perform an extended trochanteric osteotomy (ETO) to remove the existing stem. Instead, he uses a variety of tools to remove the stem, a process that took about 20 minutes but was successful.

    The other 3 surgical vignettes are shorter and demonstrate specific techniques:

    • In the second vignette, Dr. Nelson shows how to do an ETO in a patient with varus remodeling of the femur.
    • In the third vignette, Dr. Nelson demonstrates removal of a well-fixed acetabular cup in a patient with polyethylene wear, osteolysis, and symptoms, of instability.
    • In the fourth vignette, Dr. Nelson operates on another patient with an infection, demonstrating how to manage bone loss through the use of augments to obtain biologic fixation.

    Click the image above to view the video case report.