46 years old adult male presented with dislocation of the prosthesis after total hip arthroplasty surgery. The surgery was done elsewhere and he came to OPD with complains of limb deformity and pain on weight bearing.
His xray revealed a acetabular cup in unacceptable position. The cup was placed in too much retroversion. Also could be noted thick layer of cement applied to the cup. The placement of the cup in unacceptable version made the femoral component dislocate it after weight bearing.
The patient was planned for revision arthroplasty of the cup. In this surgery only cup at fault would be changed. Femoral stem was not to be disturbed.
Thus a revision of acetabular cup was done.
The surgery went well without any event and patient’s postoperative period was uneventful too.
Following images are of the removed acetabular cup from previous surgery.
Note the excessive cement present.
here is the same cup from another angle.
The patient recovered normally after the revision arthroplasty.
It must be emphasized that arthroplasty or joint replacement surgeries are salvage surgeries and should be performed after mastering the craft. Every procedure carries a risk of failure but proper training and precaution the surgeon factors could be avoided.
In the present case there was excessive retroversion. In this position the cup could not contain the femoral component and dislocated. This could have been avoided by proper version. The excessive cement placement could have interfered with proper placement of the cup into the acetabulum.
Femoral and acetabular versions are very important components of the joint replacement surgery.
The patient was followed latest after 2 years of surgery. he walks without limb and the prosthesis is holding well with femoral head having congruent containment by the newly implanted cup.
The photographs of the acetabular cup are being shared as interesting photographs.