Complication case - When everything goes wrong Again and again

Hip
Complication
Complication case - When everything goes wrong Again and again

Discover the challenging case of a 79-year-old woman with a Parker score of 2 and significant medical history including bilateral femoral neck fractures, osteonecrosis and secondary displacement

Bilateral hip arthroplasty was planned, but the team encountered multiple difficulties, such as per operative fracture and secondary displacement. Discover how these complications were managed using advanced revision techniques

Nicolas Reina
CHU Toulouse, FRANCE
Course Director

Professor Reina is Head of Hip and Trauma department, of the University Hospital in Toulouse, France. He holds a PhD in Anthropobiology. He completed a fellowship in Oxford, UK and worked in Mayo Clinic, Rochester for research.

His main focus is hip & pelvis surgery. His clinical practice comprises conservative surgery, primary and complex revision total hip arthroplasty as well as trauma for complex acetabular fractures.

Board member of French Hip Knee Surgery, he is also member of the European Hip Society and the International Board of the American Association of Hip Knee Surgeons. He published more than 150 peer reviewed publications and book chapters, and lectured in various international conferences. His research interests integrate big data in orthopedics, modern care in hip surgery such as minimally invasive techniques, and musculoskeletal system’s ability to adapt to its environment (biomechanics and anthropological variability).

Part one
Clinical presentation

Mrs R.

  • 79 ans 
  • Medical background : high blood pressure, type 2 diabetes
  • Parker score : 2
  • Surgical history : 
    • triple screwing on right femoral neck fracture (2022)
    • DHS plate for left femoral neck fracture (2022)   
    • Osteonecrosis and secondary displacement (2023)
Triple screwing on right femoral neck fracture (2022) DHS plate for left femoral neck fracture (2022),  osteonecrosis and secondary displacement (2023)
Part two
Final strategy decision

Hip planification

Hip planification

Per operative distal femur fracture requiring plate osteosynthesis

Per operative distal femur fracture requiring plate osteosynthesis

Hip planification of the right hip  

Hip planification of the right hip

Hip surgery 

  • Total hip  arthroplasty
  • Poor acetabular bone quality requiring the placement of a support ring (Kerboull cross)
Hip surgery

Secondary displacement at one month

Secondary displacement at one month

Surgical revision : Burch Schneider ring 

  • Follow up consultation (1 month)
  • Good evolution 
  • No loosening 
  • Walk without pain 
Surgical revision : Burch Schneider ring

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