• 57-year-old gentleman
• Medical history: high blood pressure, right THR post-traumatic in 1993
• Right hip pain increasing for more than 10 years but patient was scared to see a specialist.
• Walks with 1 cane
• Lower Limb Discrepancy of 3cm
• Lateral and anterior incision on the hip not inflammatory
• Range Of Motion: 90 / 0 / 30 / 30 / 20 / 0
• Palpation of a soft mass in the groin
• Blood sample: normal hemogram and CRP <5

What additional imaging or test do you ask?

• ✔️Hip aspiration for cytology, bacteriology and pathology
• ✔️CT and Arterio-CT 

What are your diagnostic hypotheses?

• ✔️Metallosis (ARMD)
• ✔️Poly wear ?
• ✔️Infection
• ✔️Sarcoma/Tumour

Infection and cancer work-up were negative

A hip revision with a stemmed cup (transtrochanteric approach for gluts) and Allograft Prosthetic Composites was performed.

A Lagrange and Letournel femoral cemented stem was implanted

Continuation of the patient's medical journey

At post-op day 1, the patient had increased pain, a sensation of instability and a sciatic nerve palsy (new).

A removal of the cup (in the sciatic nerve) was done.

2 months after (without weight bearing and denutrition) a complex cup revision was performed.

But... We noticed after removal of the drapes a massive knee instability that was not known before, and we asked for an x-ray.

Internal fixation was impossible because there wasn’t enough bone distally. A Hinge TKR and a  bridging plate were fitted.

But it’s not finished…

• At post-op day 12, hip and knee wounds were purulent, T°C was at 39°C and CRP at 300
• Patient underwent DAIR of hip + femur + knee
• At post-op day 17 of the second surgery, CRP increased again at 250 (after having decreased), both wounds were inflammatory, T°C was 38°C (patient was under effective bi-antibiotherapy)
• A 2nd DAIR procedure was performed
• 2 weeks after, same septic failure happened and patient dislocated (several times)

 A 2-stage surgery was planned: 1st stage of ilio-tibial spacer then total femur.

• During 1st stage, blood loss was massive (15 red cell units) and the patient was hemodynamically very unstable +++
• We decided to close for hemostasis purposes before implantation of the spacer and decided on a hip disarticulation after the patient stabilised…

A hip disarticulation was done one week later.