Revision THA for a severe periprosthetic hip fracture
This is a 76 year old male who was transferred in from another hospital with a severe periprosthetic hip fracture. He underwent hip replacement 25 years prior with an excellent outcome. Unfortunately, he fell down a flight of stairs after losing his balance.
X-rays demonstrated a very challenging Vancouver B3/Paprosky IV equivalent periprosthetic fracture with minimal remaining diaphyseal bone stock. To complicate matters further, the patient is a very large individual at 6’3, 295lbs.
The femur was revised using the largest modular tapered titanium revision stem that exists (31x290mm distal stem, 28x105mm proximal body). Cortical strut allografts, multiple cerclage cables, and a trochanteric plate were used to repair the femoral segments around the stem using a “scaffold” technique. The acetabulum was also revised given the limited options for femoral head sizes.
After an extended recovery, the patient is able to walk unassisted and has remarkably returned to playing golf.