Darwin Chen, MD

Revision of a Recalled Modular Neck THA

 

This is a 79 year old female who had a left total hip replacement by another surgeon approximately five years ago. She complained of increasing amounts of hip pain over the past 2 years and was told she had a recalled hip replacement implant. She was referred to our practice for revision surgery, as Dr. Chen is known for his experience with revision of recalled metal-on-metal hip implants. Dr. Chen has previously published on surgical techniques to remove recalled implants.

 

 

Preoperatively, her workup showed no signs of infection. X-rays demonstrated a modular neck femoral stem (two piece implant) which had been recalled due to corrosion at the neck/body junction. The implants were well fixed, and the acetabular component had inadequate anteversion. Her cobalt level was elevated at 7.2 μg/L, and her chromium level was 2.3 μg/L. A metal subtraction MRI was obtained which demonstrated a large fluid collection and adverse local tissue reaction (ALTR).

During surgery, significant soft tissue damage from the prior implant was encountered. The femoral stem was successfully removed without an extended osteotomy, using the “over the top” Steinmann pin technique. The acetabular component was revised as well, placing the new socket in the correct anatomic position. A ceramic on polyethylene bearing surface was used to minimize the risk of further metal toxicity.

Postoperatively, the patient was made weight bearing as tolerated. She did well without complication and is currently able to walk unassisted with minimal symptoms.

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