Clinical History, Examination and Blood Test Results

  • Workshop 5 is a 76-year old gentleman who presented with indolent left hip pain worsening over 2-years.

  • He had a background of trauma to the left hip resulting in fracture requiring a left total hip replacement. This was a hybrid hip replacement (uncemented stem with a cemented socket). He made a good recovery from this procedure.

  • One year later he experienced pain from the left hip, requiring ibuprofen to control.

  • He presented to his local hospital one year later. At the time of presentation, some investigations demonstrated;

    • ESR of 27mm/H which was not abnormal for this patient

    • Radiograph demonstrating 10mm of stem subsidence between 1-year post-op and the time of presentation (roughly a year)

    • Culture negative hip aspiration

    • MRI spine demonstrating L2 stenosis

  • A year on he was referred to our service. On examination he had an antalgic short leg gait and was Trendelenburg test positive on the left side. He used a walking stick for mobilising. He only had 40% lumbar spine motion. Range of movement in the left hip was reduced due to pain. Sensation was reduced in all dermatomes of the left leg.

  • His pre-operative Oxford hip score was 18/48.

  • Investigations at this time demonstrated;

    • CRP of 3.6mg/L and an ESR of 19mm/H helping to rule out infection

  • CT SPECT demonstrating high uptake around the neck and tip of the implanted stem

Imaging Results


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This CT SPECT scan shows increased uptake of the tracer around the lesser trochanter and the tip of the femoral stem, a common radiological manifestation of aseptic loosening.

This bone scintigraphy scan demonstrates increased uptake of trace in the same areas as the SPECT CT adding to the suspicion of aseptic loosening.


  • Loose left femoral stem requiring revision.


This patient required revision of the left femoral component only. The acetabular component remained well fixed from the first procedure.

  • Intraoperatively;

    • Posterior approach

    • 4 stay sutures placed

    • Stem found to be loose, socket was well fixed

    • Stem removed

    • MP link stem 14 x 210mm with XXL body and medium 36mm ceramic head implanted

    • This achieved stability and a good length

    • Closure with vicryl, monocryl and glue

Imaging Outcomes


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This series of radiographs demonstrates the position of the stem post-operatively with the retained acetabular component.


Clinical Outcomes

  • Excellent patient outcome 1 year post surgery at the age of 88 years old. No support needed for walking distances of more than 1 mile.

Learning Points

  • CT spect shows which components loose, allowing retention of well fixed components if well positioned and no infection present.

  • Revision surgery in octogenarians should not be refused due to age.