Abstract
Thigh pain and periprosthetic osteolysis associated with the femoral stem, is a common complication of cementless total hip arthroplasty. Treatment of this disabling complication is difficult but usually requires revision of the femoral stem, which is a procedure not without further morbidity. We describe a solution which does not require revision and which brought about resolution of the thigh pain.
The patient was a 79 year old male who had a primary Total hip replacement (year 1998),This was revised (early 2001) to an uncemented cup (ABG type) and uncemented femoral component (Link MP stem) . He continued to experience disabling thigh pain which limited walking to only a few yards.The pain was thought to be related to concomitant paget’s disease in the Right hemipelvis and proximal femur. Rheumatology assessment and treatment with IV Pamidronate (three courses of treatment) did not produce any relief of pain and indicated a mechanical prosthesis related cause of pain. Radiology assessment was also indicating the same with osteolysis at the tip of the prosthesis.
The patient did not want a further revision procedure, but wanted relief of pain.Therfore sufgicsl intervention to treat the osteolysis with allograft ground bone introdued retrogradely via an anterior knee approach with an intercondylar pilot hole and initial supracondylar reaming. Allograft was introduced using a 5 ml syringe and impacted with a 1 cm diameter metal rod. 50 ml of ground bone was introduced and impacted forcibly with rod and hammer impaction.
The knee wound was closed in layers over 2 drains and post-op management was same as for total knee replacement, CPM and active NWB mobilization for six weeks followed by PWB, progressing to full weight bearing mobilization. Walking was free of thigh pain and walking distance was improved.
Theses abstracts were prepared by Mr Peter Kay. Correspondence should be address to him at The Hip Centre, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP.
