Thread by @jointdocShields

A thread 🧵
Very interesting case with a lot of teaching points

Elderly female with moderate hip pain - underwent right IA hip injection at OSH
#orthotwitter

2 months later presented with worsening hip pain

X-rays show AVN with collapse -

- do not inject hips in elderly females - high risk of AVN with collapse

Patient went on to get a THA at OSH. Intra-operatively could not get the cup to stick. Bail out was to cement a cementless cup. Chose blade type prosthesis - cracked the calcar, managed with cables

- if a cup will not stick there is usually a reason. Fracture? Up to size? Bone loss? Push medial?

- for these elderly females consider fit and fill stem vs cemented

Patient went on to stem subsidence and cup failure secondary to loosening - presented to our clinic with this construct and unable to bear full weight

- cement predictably failed on the bone side

Revised all - found a posterior column fracture which explains initial cup concerns. Plated column, redapt cup, femoral head allograft with montage bone graft to cover medial defect. Redapt stem. Dual mobility

Had cage available as a backup but not needed after plate

@generalorthomd @CenterRotation @DrChadKrueger @kneedoclond @BrianChalmersMD @orthogal21 @hjluks