Darwin Chen, MD

Bilateral THA revision for severe varus remodeling

 

This is a 42 year old female with a history of a rare condition called focal segmental glomeruloscelrosis (FSGS). Her kidneys failed, requiring two kidney transplants. As a side effect of her treatments, she developed avascular necrosis (AVN) of the hips, a condition where the femoral head (ball of the hip joint) loses its blood supply. She underwent bilateral hip hemiarthroplasty (partial hip replacement) at another institution 10 years ago.

She presented to Dr. Chen with inability to walk due to severe bilateral hip pain. Her legs became increasingly bowed and her feet turned outwards. X-rays demonstrated loose hemiarthroplasty implants on both sides with stem subsidence, severe varus remodeling, and retroversion. To complicate matters further, a thorough workup revealed that the right hip was also infected.

She underwent three reconstructive surgeries over the course of one year. She first underwent removal of the infected right hip hemiarthroplasty. A long extended trochanteric osteotomy (ETO) was used for stem and cement removal. Due to the severe femoral remodeling, a static antibiotic spacer using a Rush rod was placed. She was treated with IV antibiotics for 6 weeks. She underwent second stage reimplantation 3 months later. Femoral reconstruction was achieved using a modular tapered titanium stem. A second medial proximal femoral corrective osteotomy was performed due to the severe amount of varus remodeling. A dual mobility acetabular component was used to minimize the risk of dislocation.

She did well postoperatively and her complex right hip reconstruction healed without issue. She returned for revision surgery of the left hip. A similar long ETO with medial femoral corrective osteotomy was performed to provide deformity correction and proper implantation of a straight revision femoral stem. Femoral cortical strut allografts were used to reinforce her thin diaphyseal femoral bone envelope.

The patient has done extremely well from these challenging reconstructive surgeries. She is able to walk without any devices and has no pain.

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