CCANTER
Networker
i am not sure if this would be considered revision of both components? or is just the acetabular component
PREOPERATIVE DIAGNOSIS:
Failed left total hip arthroplasty.
POSTOPERATIVE DIAGNOSIS:
Failed left total hip arthroplasty.
PROCEDURE PERFORMED:
Revision left total hip arthroplasty.
Prior incision was reopened. Skin flaps elevated. Dissected through the adipose tissue into the tensor fascia and gluteus, which were re-split. The Charnley retractor inserted. The hip internally rotated. We cut through the short external rotators and the scar tissue until we encountered the capsule, which was opened. No evidence of any infectious process was present. After excision of a generous amount of scar, we were able to dislocate the hip and remove the ceramic head. Acetabular retractor was inserted, which allowed us exposure of the acetabulum. After careful dissection, we were able to remove the poly, remove the screw, and were able to remove the prior acetabular cup without too much difficulty.
On a sterile field, we took an allograft femoral head. I removed half of the superior half of the head and then morselized the distal part of the graft. I mixed DBM bone graft into that morselized cancellous bone.
We placed the superior humeral head graft into the medial wall and then inserted the morselized bone graft. We then inserted a reamer in reverse, which provided a lot of inherent stability to the medial column.
We then began to ream into the anatomic acetabulum. We reamed up to a size 56, getting good circumferential bleeding bone. We inserted a Pinnacle revision shell in 45 degrees inclination, anatomic anteversion, inserted 2 peripheral screws and a centered dome screw in zone 1. This gave us really nice stability of the revision cup. After lavage, we inserted the metal internal liner and security was confirmed.
We then inserted a dual-mobility trial and then brought in live fluoroscopy to check position of the cup and the screws.
The trial was dislocated. We again lavaged with Betadine wash. We inserted the dual-mobility head and reduced the joint. Again, excellent stability was confirmed.
The tensor fascia and gluteus were then closed with #2 Ethibond, 0 Monocryl closed the adipose layers in layers, staples closed the skin. Steri-Strips applied. TED hose, abduction pillow. The patient taken to recovery room in stable condition.
PREOPERATIVE DIAGNOSIS:
Failed left total hip arthroplasty.
POSTOPERATIVE DIAGNOSIS:
Failed left total hip arthroplasty.
PROCEDURE PERFORMED:
Revision left total hip arthroplasty.
Prior incision was reopened. Skin flaps elevated. Dissected through the adipose tissue into the tensor fascia and gluteus, which were re-split. The Charnley retractor inserted. The hip internally rotated. We cut through the short external rotators and the scar tissue until we encountered the capsule, which was opened. No evidence of any infectious process was present. After excision of a generous amount of scar, we were able to dislocate the hip and remove the ceramic head. Acetabular retractor was inserted, which allowed us exposure of the acetabulum. After careful dissection, we were able to remove the poly, remove the screw, and were able to remove the prior acetabular cup without too much difficulty.
On a sterile field, we took an allograft femoral head. I removed half of the superior half of the head and then morselized the distal part of the graft. I mixed DBM bone graft into that morselized cancellous bone.
We placed the superior humeral head graft into the medial wall and then inserted the morselized bone graft. We then inserted a reamer in reverse, which provided a lot of inherent stability to the medial column.
We then began to ream into the anatomic acetabulum. We reamed up to a size 56, getting good circumferential bleeding bone. We inserted a Pinnacle revision shell in 45 degrees inclination, anatomic anteversion, inserted 2 peripheral screws and a centered dome screw in zone 1. This gave us really nice stability of the revision cup. After lavage, we inserted the metal internal liner and security was confirmed.
We then inserted a dual-mobility trial and then brought in live fluoroscopy to check position of the cup and the screws.
The trial was dislocated. We again lavaged with Betadine wash. We inserted the dual-mobility head and reduced the joint. Again, excellent stability was confirmed.
The tensor fascia and gluteus were then closed with #2 Ethibond, 0 Monocryl closed the adipose layers in layers, staples closed the skin. Steri-Strips applied. TED hose, abduction pillow. The patient taken to recovery room in stable condition.