Dr. Sanz-Ruiz

69-year-old female patient

Department orthopedic surgery,
Gregorio Marañon hospital, Madrid, Spain

Preoperative X-ray, June 2021

1994: Primary THA right, secondary Perthes disease (other centre)
2006: Acetabular revision due to polyethylene wear (other centre)
2011: Femoral revision with a long stem (SROM) due to aseptic loosening (other centre)
2013: Trochanteric fracture fix it with plate (other centre)
06/2021: Introduction with..
- Supracondylar femoral fracture after fall just in the tip of the long hip stem
- Radiological loosening of the stem
- Hip joint ankylosis (heterotopic calcification grade 3)

X-ray after surgery, June 2021

06/2021: complete THA removal, defect classification acetabulum: IIC, defect classification femur: IIIA, Distal comminute supracondylar fracture
06/2021: Reimplantation THA right with..
- Extended trochanteric osteotomy was made to remove previous stem, due to bad bone quality, previous heterotopic calcification and to avoid trochanteric crack
- Good bone cover was obtained with hemispheric cup using bone graft in the medial wall to restore the bone stock and center of rotation
- Due to the limitation of the synthesis of femoral fracture and high risk of new fracture with to stem (hip and knee) we decide to do a intramedullary total femur arthroplasty with a endomodel tibial component , Mega C push through and endomodel femoral distal supplement
- Dual Mobility Insert was used to decrease the dislocation risk
- A new plate was used to close the ETO due to extremely bad bone quality
Components:
- MobileLink TrabecuLink Multi Hole Shell, size 58; Dual Mobility Insert / size E, Bone Screws 6.5 / 50 mm x 2; 6.5 / 30 mm and 6.5 / 25 mm
- Mega C push-through 14 x 240 mm
- Endomodel M small, tibial stem 95 mm, and distal femoral replacement augment 50mm
- MP short metaphysis XXL CCD 126º

Postoperative X-ray, 12-week follow-up

The modular MobileLink Acetabular Cup System allowed a good fixation, with the possibility of after fixation recon the COR. In this case, it was not necessary, however we can use a Dual Mobility Insert to decrease the risk of dislocation.
The result was excellent. The patients is walking without pain and she doesn´t need any assistance device to walk.
X-ray after 12 weeks:
- Secure acetabular cup integrated and perfect function of intramedular total femur arthroplasty