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Total Hip Arthroplasty Using a Polished Tapered Cemented Stem in Hereditary Multiple Exostosis.

Kanda A, Kaneko K, Obayashi O, Mogami A - Case Rep Orthop (2016)

Bottom Line: On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck.He had also developed coxarthrosis and severe pain of the hip joint.The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Izunagaoka 1129, Izunokuni, Shizuoka 410-2295, Japan.

ABSTRACT
A 61-year-old Japanese man underwent right total hip arthroplasty for hereditary multiple exostosis. At first presentation, he had suffered from coxalgia for a long time. On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck. He had also developed coxarthrosis and severe pain of the hip joint. The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis. Therefore, total hip arthroplasty using a cemented polished tapered stem was performed via a direct lateral approach. Using a cemented polished tapered stem allowed us to deal with the femoral bone transformation and bone substance defectiveness due to exostosis and also minimized the invasiveness of the operation.

No MeSH data available.


Related in: MedlinePlus

Photograph of the implant in place. We stabilized the fractured greater trochanter with tension band wiring using Kirschner wire and nylon tape.
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fig6: Photograph of the implant in place. We stabilized the fractured greater trochanter with tension band wiring using Kirschner wire and nylon tape.

Mentions: Right total hip arthroplasty was performed using the direct lateral approach. The soft tissue appeared normal, and an incision was made in the articular capsule. A gigantic femoral head and large diameter of the femoral neck were noted. There was no evidence of exostosis with a cartilage hat. Hip dislocation was difficult because of the gigantic femoral head and caused a trochanteric fracture. The bone substance of the greater trochanter, femoral neck, and femoral trochanter was poor and showed bone fragility. The acetabular side cartilage and femoral head cartilage showed degeneration (Figure 4). We implanted an acetabular cup by press fit without screws at the site of the original acetabulum, because the bone substance there was in good condition. We then performed an osteotomy in a more distal than usual part of the femoral neck, because the bone substance of the femoral trochanter was poor and exostosis was evident in the femoral trochanter on preoperative radiography. We implanted a femoral polished tapered stem using bone cement because of the poor bone substance of the femoral trochanter and the expanded medullary cavity of the proximal femur (Figure 5). We fixed the fractured greater trochanter with tension band wiring using Kirschner wire and nylon tape (Figure 6). We then repaired the articular capsule, gluteus minimus muscle, gluteus medius muscle, and tensor fasciae latae muscle.


Total Hip Arthroplasty Using a Polished Tapered Cemented Stem in Hereditary Multiple Exostosis.

Kanda A, Kaneko K, Obayashi O, Mogami A - Case Rep Orthop (2016)

Photograph of the implant in place. We stabilized the fractured greater trochanter with tension band wiring using Kirschner wire and nylon tape.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835646&req=5

fig6: Photograph of the implant in place. We stabilized the fractured greater trochanter with tension band wiring using Kirschner wire and nylon tape.
Mentions: Right total hip arthroplasty was performed using the direct lateral approach. The soft tissue appeared normal, and an incision was made in the articular capsule. A gigantic femoral head and large diameter of the femoral neck were noted. There was no evidence of exostosis with a cartilage hat. Hip dislocation was difficult because of the gigantic femoral head and caused a trochanteric fracture. The bone substance of the greater trochanter, femoral neck, and femoral trochanter was poor and showed bone fragility. The acetabular side cartilage and femoral head cartilage showed degeneration (Figure 4). We implanted an acetabular cup by press fit without screws at the site of the original acetabulum, because the bone substance there was in good condition. We then performed an osteotomy in a more distal than usual part of the femoral neck, because the bone substance of the femoral trochanter was poor and exostosis was evident in the femoral trochanter on preoperative radiography. We implanted a femoral polished tapered stem using bone cement because of the poor bone substance of the femoral trochanter and the expanded medullary cavity of the proximal femur (Figure 5). We fixed the fractured greater trochanter with tension band wiring using Kirschner wire and nylon tape (Figure 6). We then repaired the articular capsule, gluteus minimus muscle, gluteus medius muscle, and tensor fasciae latae muscle.

Bottom Line: On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck.He had also developed coxarthrosis and severe pain of the hip joint.The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Izunagaoka 1129, Izunokuni, Shizuoka 410-2295, Japan.

ABSTRACT
A 61-year-old Japanese man underwent right total hip arthroplasty for hereditary multiple exostosis. At first presentation, he had suffered from coxalgia for a long time. On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck. He had also developed coxarthrosis and severe pain of the hip joint. The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis. Therefore, total hip arthroplasty using a cemented polished tapered stem was performed via a direct lateral approach. Using a cemented polished tapered stem allowed us to deal with the femoral bone transformation and bone substance defectiveness due to exostosis and also minimized the invasiveness of the operation.

No MeSH data available.


Related in: MedlinePlus