The Story

“Helen presented to us aged 47. She came to my clinic as she was suffering with worsening back pain and reducing mobility because of this. As a young woman, Helen had suffered with a right slipped upper femoral epiphysis which was pinned and then fused. After extensive investigation by the spinal surgeons, we deduced that her ongoing back pain was secondary to her arthrodesis, and was not related to any new spinal pathology.”

To be checked by PROF


The Investigation

To be completed by ROB

  • Her Oxford Hip Score for the right hip was 13/48


The Evidence

Anteroposterior plain radiograph demonstrating fusion of the right hip joint with an arthrodesis plate. Her left hip joint looks healthy with minimal degenerative change.

Coronal MRI - We us the pre-operative MRI scan to evaluate the soft tissue and muscle bulk around the right hip. For Helen, this MRI demonstrates global muscle atrophy surrounding the right hip, which is to be expected with a hip fusion.

 

Coronal CT - This scan was performed before the operation in order to aid in the planning of Helen’s surgery.

 

The Diagnosis

Helen was experiencing back pain and mobility issues because of her right sided arthrodesis fusing the joint


The Plan

Helen was a very good candidate for an SROM femoral stem. This modular femoral component is an off the shelf system. It allows for the surgeon to select different components of the stem intraoperatively to allow for up to 10,398 different combinations to perfectly match the patients anatomy. Parameters such as the sleeve, stem length, proximal body type and head can be altered.

To be checked by PROF

 
 

SROM component from left to right: 1) Trial components of the SROM. 2) Final implant demonstrating a fluted distal segment for increased stability. 3) Close up of the distal stem.


The Operation

To be completed by ROB


The Outcome

Anteroposterior plain radiograph showing that the SROM is in a satisfactory position the day after her operation.

Anteroposterior plain radiograph taken at Helen’s one year follow-up appointment. The implant hasn't moved from the immediate post-operative radiograph and there is evidence of bony healing.

Helen returned to our clinic one year after her procedure and with a lot of extensive physiotherapy to improve her muscle bulk, her mobility had improved massively. She was independently mobilising without any aids and her back pain had resolved. On clinical examination she had a very good range of motion and she was Trendelenburg test negative. We were both very happy with the final result.

 

Trendelenburg test performed when Helen returned to clinic one year after her operation. Her pelvis is level meaning the test is negative. This is a good clinical indicator that the muscle bulk around her right hip has vastly improved.

 

The Verdict

To be completed by Prof


Evidence for this Treatment

  • Needed


In closer Detail

  • Needed


Related cases…

  • Needed