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Revision Total Hip Arthroplasty

(See also: Total Hip Replacement Menu)

Discussion

Examination

  • examination for loosening:
  • previoius incisions;
  • contracture of the flexors and adductors (adds to complexity of the case);
  • impingement: tenderness to forced internal rotation may indicate anterior impingement;
  • leg-length inequality is noted;
  • neurovascular status of the limbs is recorded (EMG can be ordered if necessary);
  • trendelenburg gait:
    • power of the abductor muscles is noted;
    • marked Trendelenburg gait may indicate that abductors are non functional;
    • may be due to paralysis or loss of continuity;
    • if no trochanteric frx is present, then consider EMG to evaluate for paralysis;

PreOp Planning » (radiographs, equipment, implant selection);

Surgical Approach »

surgical dislocation of hip

  • because femur usually has been weakened owing to cortical defects or cavitation, great care is taken in dislocating hip and exposing femur to avoid fracture;
  • greater trochanter osteotomy will facilatitate dislocation;
  • the entire pseudocapsule is excised or released;

need for tissue biopsy cultures from the component membrane interface

femoral component revision »

acetabular component revision »

Post Op Anesthesia

  • Local Analgesia Infiltration Techniques – Hip and Knee Arthroplasty