Clinical History, Examination and Blood Test Results

  • Step 5 case 1 is a 47 year old woman who had a previous right hip slipped capital epiphysis, which was initially pinned and later fused.  

  • She has suffered with back pain as a result of the arthrodesis, with poor mobility.  She has been investigated by spinal surgeons who found no spinal cause of the pain.  

  • Her initial Oxford Hip Score was 13/48.


Imaging Results

PRE-OP RADIOGRAPH

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This shows surgical fusion of the right hip joint.

 

PRE-OP MRI 

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PRE-OP CT 

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The CT scan allows the surgeon to plan surgery by analysis of multiple 'slices' of the hip.


The MRI allows evaluation of soft tissue status and muscle bulk.  There is global muscle atrophy surrounding the right hip, which is to be expected with a hip fusion.


Diagnosis

  • Painful fused right hip joint with previous arthrodesis causing poor mobility and back pain.


Treatment

S-ROM - LONG MODULAR STEM

Image 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. This gives 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).

 

Imaging Outcomes

POST-OP RADIOGRAPH

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ONE YEAR POST-OP RADIOGRAPH

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This shows satisfactory positioning of the implant.  The patient now has a very good range of motion, is independently mobilising, and has improvement in the back pain symptoms as a result of the surgery.

This radiograph was taken at one year post-op. The implant hasn't moved from the immediate post-operative radiograph. There is evidence of bony healing.


Clinical Outcomes

  • The patient now has a very good range of motion, is independently mobilising, and has improvement in the back pain symptoms as a result of the surgery.

 

ONE-YEAR POST-OP TRENDELENBURG

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This image shows the patient completing the trendelenburg test one year after her procedure.

 

Learning Points

  • A problematic hip joint can cause symptoms elsewhere, in this case pain in the back.

  • A long modular stem is useful to achieve a stable femoral implant in these difficult cases.