Clinical History, Examination and Blood Test Results

  • Workshop case 4 presents a 49-year-old man with 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 had been removed.

  • He has severe pain and restriction of movements in the right hip and a leg length discrepancy (right shorter than left). The left hip has already been been operated on.


Imaging Results

PRE-OP RADIOGRAPH

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This shows severe deformity of the right hip, with shortening of the right leg compared to the left.

 

PRE-OP CT SCAN

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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 of the CT scan 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 on the CT scan.


Diagnosis

  • This patient was diagnosed with severe femoral deformity on the right side due to end stage osteoarthritis.


Treatment

S ROM - Long modular stem

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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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This anteroposterior radiograph of the pelvis shows the right sided S-ROM in situ after the operation.

 

Clinical Outcomes

  • The patient has made a good recovery and is much more mobile and pain-free as a result of the operation.


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.