Primary Hip Arthroplasty Case Title: Bilateral Simultaneous THAs Using Uncemented Monobloc All HXLP Acetabular Components

Advanced osteoarthritis bilaterally. Osteonecrosis and complete obliteration of the joint space on both sides. Bilateral simultaneous THA using monobloc acetabular all poly components (Mathys Vitamys) and ceramic heads (Fig. 3.1)

 

 

 

 

Fig. 3.1 (a) Preoperative pelvic x-ray (b) Postoperative pelvic x-ray demonstrating bilateral uncemented monoblock THAs

 

Case Title: Primary Cemented Total Hip Arthroplasty

 

Demographics

 

Age: 43

Sex: Male, retired army officer (for medical reasons)

BMI: 30

 

Relevant Past Medical History

 

Principal pathologies: Rheumatoid arthritis, osteoporosis and pulmonary fibrosis.

Medication: Injection of etanercept, metho-trexate, alendronate, calcium carbonate, prednisolone and sulfasalazine.

History of presenting complaint: Pain of the left hip.

 

Preoperative Radiological

Assessment/Imaging (Fig. 3.2)

 

 

 

 

Fig. 3.2 This is a typical rheumatoid arthritis radiograph demonstrating the global destruction of the articular cartilage of the left hip joint and evident osteoporosis from disuse osteopenia and long-term use of corticosteroids

Preoperative Planning

 

Diagnosis: Osteoarthritis of the left hip (RA) (Fig. 3.2).

Possible treatment options: For those people who have severe rheumatoid arthritis, cemented implants performing very well compared to uncemented implants. Although there is some conflicting evidence for the latter, in our opinion and experience, cement allows for early rehabilitation and better long-term results and survival of the prosthesis.

Chosen treatment method: Cemented cup Depuy 43 mm/28 mm Monobloc, cemented hip stem Stryker Exeter 44–2, 150 mm and ceramic femoral head Stryker 28 mm, 0 mm.

 

Surgical Note

 

This is a box standard cemented Exeter triple hip arthroplasty including both sides. The third-generation cementing technique was employed using bone aspirators for blood and intensive drying of the cancellous bone before pressurizing the cement in. A minimum of 2 mm of cement mantle was necessary for better interlocking with the deficient cancellous bone (Fig. 3.3).

Patient’s position: Lateral decubitus.

Type of anaesthesia: General.

Surgical approach: Direct Superior.

 

Postoperative Radiographs

(Fig. 3.3)

 

 

 

Fig. 3.3 The leg length has been recovered compared to the preoperative radiograph; the cement mantle is adequate on both sides, and the orientation of the implant is satisfactory

 

Postoperative Management

 

Chemoprophylaxis and anticoagulant treatment period: Cefuroxime 750 mg 1 × 3 for one day and ciprofloxacin 400 mg 1 × 2 for two days, vancomycin 500 mg 1 × 2 for two days, tinzaparin 1 × 1 for the days of hospitalization and then rivaroxaban for thirty days.

Gait/limb loading until full loading: Partial weight-bearing for four weeks. At six weeks, full weight-bearing and without an assistive device.

 

Follow-Up and Complications

 

It is usually expected to wait a minimum of two weeks after surgery before starting the medication again for the treatment of rheumatoid arthritis. The reason is to protect wound healing and prevent joint infection. Although there is no significant evidence to suggest extensive perioperative antibiotic prophylaxis, in our experi-

ence, we advise extending the prophylaxis to five days instead of 24 h postoperatively. In this particular case, obesity was an additional reason for doing so.