Clinical History

  • This 49 year old man had bilateral end stage osteoarthritis with complex deformities of both proximal femurs due to slipped capital femoral epiphysis as a child.  Both hips previously underwent pinning and the pins have been removed.
     
  • He had severe pain and restriction of movements in both hips and a leg length discrepancy (right shorter than left).
     
  • He had previously had his left hip replaced with a modular long stem (S ROM).

Diagnosis

PRE-OP RADIOGRAPH

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This shows severe deformity of the right hip, with an S ROM implant in the left hip.

This shows the severe deformity of the right hip.  The CT scan allows the surgeon a better appreciation of the deformity and helps with accurate planning for surgery.

3D CT RECONSTRUCTION

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 Images 1-4 A 3D reconstruction of the femur allows the surgeon to manipulate the images and define the bony anatomy in preparation for surgery.

Image 5 (3D CT planning for S ROM) Specialised software can help the surgeon plan the size and combination of components for the implant based upon the CT scan.


Treatment

S ROM

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mage 1 (Trial components of S ROM) This is a long modular stem, with the ability to vary the sleeve, stem length, proximal body type and head resulting in 10,398 combinations to suit the individual patient anatomy.

Image 2 (Final implant) The distal segment is fluted providing stability in the distal bone.

 Image 3 (close up of fluted distal segment).


Clinical Outcomes

POST-OP RADIOGRAPH

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This shows satisfactory positioning of the implants. He has made a good recovery and is much more mobile and pain free as a result.


Learning Points

A modular long femoral stem allows the surgeon to correct for severe deformity with a large number of options to suit the patient’s anatomy.

3D CT reconstruction helps the surgeon appreciate the pathological anatomy and therefore plan surgery.