Dedication
Acknowledgments
About the Editor
Contributing Authors
Preface

Section I: Preoperative General Questions

Question 1

I Have a 43-Year-Old Male Who Needs a Total Hip Arthroplasty. Should I Use Highly Cross-Linked Polyethylene, Ceramic, or a Metal-on-Metal Bearing Surface? Scott M. Sporer, MD

Question 2

I Have a Patient With Both Back and Hip Arthritis. How Do I Determine Which Is Most Problematic and Causing the Patient’s Symptoms?
Matt Squire, MD, MS and Richard Illgen

Question 3

I Have a Patient With Severe Bilateral Hip Degenerative Arthritis. Do I Perform Bilateral Total Hip Replacement, or Do I Stage the Surgery? If I Do Stage the Surgery, How Long Should I Wait?
Keith R. Berend, MD and Jorge Aziz, MD

Question 4

How Do You Decide When a Patient Is “Ready” for a Total Hip Replacement? Is There a Downside to Waiting Until He or She Has More Severe Disease?
Vivek Sood

Question 5

I Have a 58-Year-Old Female Alcoholic Patient Who Fell and Has a Femoral Neck Fracture. What Surgical Approach Should I Use to Treat his Fracture, and What Component Should I Use?
James Ryan, MD and Paul E. Di Cesare, MD

Question 6

A 65-Year-Old Patient Fell and Has a Displaced Femoral Neck Fracture. Should I Do a Hemiarthroplasty or a Total Hip Arthroplasty?
Thomas E. Brown, MD; Khaled Saleh, MD, MSc, FRCS; Quanjun Cui, MD; and William Mihalko, MD, PhD

Question 7

I Have a 63-Year-Old Patient Who Is 6 Years Postoperative From a Total Hip Replacement. He Was Doing Very Well Until Last Week When He Began Experiencing Increasing Hip Pain Following a Dental Appointment. I Think His Hip Is Infected. What Should I Do?
Carl Diermengian

Question 8

Should All of My Patients Donate Blood Prior toTotal Joint Replacement?
Jeffrey L. Pierson, MD and R. Michael Meneghini, MD

Question 9

A 20-Year-Old Patient Suffered a Hip Dislocation in a Motor Vehicle Accident. He Has Developed Avascular Necrosis and Now Has Severe Degenerative Arthritis. How Do You Treat His Pain?
Scott M. Sporer, MD

Section II: Preoperative Acetabulum Questions

Question 10

I Have a 34-Year-Old Female With Pain in Her Hip and Groin. Her X-Rays and MRI Are “Unremarkable.” Is Her Pain From Her Hip, and How Do I Know?
Michael J. Taunton, MD and Robert T. Trousdale, MD

Question 11

I Have a Patient With a Loose Acetabular Component and a Moderate Amount of Bone Loss. How Can You Determine the Degree of Acetabular Bone Loss You Will Encounter Intraoperatively With Preoperative Radiographs?BR>Allan E. Gross, MD, FRCSC, OOnt

Question 12

I Have a 72-Year-Old Patient Who Has Severe Hip Arthritis. He Had Undergone Prior Pelvic Radiation Due to Prostate Cancer. What Type of Hip Replacement Should I Perform?
Saul Magitsky, MD

Question 13

I Have a Patient With Start-Up Groin Pain 5 Years After Surgery, and I Think the Acetabular Component Is Loose. How Can I Tell for Sure?
Amanda Marshall

Question 14

I Have a Patient With a Crowe Type III Hip Dysplasia. Where Do I Place the Acetabular Component?
Duncan Jacks, MD; Alexander W. Siegmeth, MD, FRCSC; and Bassam A. Masri, MD, FRCSC

Question 15

I Have a Patient With a Pelvic Discontinuity. What Can I Expect to Find Intraoperatively, and How Should I Plan on Reconstructing This Defect?
Daniel Berry

Question 16

I Have a Patient Who Is 10 Years Postoperative From a Hip Replacement With Severe Polyethylene Wear and Retroacetabular Osteolysis. When Do I Intervene With a Polyethylene Liner Exchange?
Raju Ghate

Question 17

I Have a Patient Who Is 10 Years Postoperative From a Hip Replacement With a Loose Acetabular Component. When Do I Need to Use More Than a Hemispherical Component?
Brian Murphy

Section III: Preoperative Femur Questions

Question 18

I Have a Patient With a Crowe Type IV Hip Dysplasia. What Femoral Component Do I Use and When Do I Need to Do a Femoral Shortening Osteotomy?
James Slover

Question 19

I Have a Patient With Start-Up Thigh Pain 5 Years After Surgery, and I Think the Femoral Component Is Loose. How Can I Tell for Sure?
Calin S. Moucha

Question 20

I Have a Patient With a Large Amount of Femoral Offset. How Do I Address This Intraoperatively?

Question 21

I Have A Patient With an Infected Well-Fixed Femoral Component. How Do I Remove This Without Destroying the Femoral Bone?
Brett Levine

Question 22

I Have a Patient With a Loose Femoral Component and Varus Remodeling of the Proximal Femur. What Surgical Approach and Implant Should I Use?
Stephen Walsh

Question 23

I Have a Patient With Distal Osteolysis and a Loose Stem. What Type of Implant Should I Use and What Bone Stock Can I Anticipate Finding at the Time of Surgery?
Mark F. Schinsky, MD

Question 24

An 84-Year-Old Female Who Had a Previous Cemented Total Hip Replacement With Severe Proximal Osteolysis Fell and Has a Periprosthetic Femur Fracture. She Has Very Little Proximal Bone.Should I Reconstruct This With Allograft Bone or Use a Tumor Prosthesis?
John L. Masonis, MD and Tom K. Fehring, MD

Section IV: Intraoperative General Questions

Question 25

I Was Placing Screws in the Acetabular Component When I Began to Experience Profuse Bleeding. What Should I Do?
David Lewallen

Question 26

A 45-Year-Old Patient Who Had a Previous Hip Fusion Is Now Complaining of Increasing Back Pain. What Should I Do?
Steve Mussett, MD and Paul E. Beaulé, MD, FRCSC

Question 27

I Am Doing a Routine Total Hip Arthroplasty and I Am Unable to Obtain Hip Stability. What Should I Do?
Hari K. Parvataneni, MD and Harry E. Rubash, MD

Section V: Intraoperative Acetabulum Questions

Question 28

I Have a Portion of the Acetabular Component Uncovered During Acetabular Revision. Is This Is Okay, and How Much Uncoverage of the Component Is Acceptable to Use a Hemispherical Component Alone?
Michael O’Rourke, MD

Question 29

I Have a Patient With Severe Segmental Bone Loss in the Superior Dome of the Acetabulum. What Should I Do to Reconstruct This Defect?
Steve Weeden and Steven Odgen

Question 30

I Am Doing an Acetabular Revision While Retaining the Femoral Component and Cannot Get the Proximal Femur Out of the Way. What Should I Do?
Andrew H. Glassman, MS, MD

Question 31

I See a Fracture While Inserting an Acetabular Component With a 2-mm Press-Fit. The Component Is No Longer Stable. Now What Should I Do?
Todd Sekundiak

Question 32

While Reaming the Acetabulum, I Inadvertently Reamed Through the Medial Wall. What Should I Do?
William Lighthart

Section VI: Intraoperative Femur Questions

Question 33

I Was Impacting a Tapered Femoral Component and I See a Small Crack of the Calcar. What Should I Do?
Michael E. Berend, MD

Question 34

I Have a Patient With Severe Osteolysis Surrounding Her Greater Trochanter During a Routine Polyethylene Liner Exchange. Do I Need to Do Anything to This Area of Bone Loss at the Time of Surgery?
William G. Hamilton, MD

Question 35

I Have a Patient With Severe Proximal Bone Loss That I Was Treating With an Extensively Coated Implant. During Insertion I Heard a Crack. What Should I Do?
R. Michael Meneghini, MD and Jeffery L. Pierson, MD

Section VII: Postoperative Questions

Question 36

When and How Do I Perform an Extended Trochanteric Osteotomy?
Michael Archibeck, MD

Question 37

I Have a Patient That is Complaining of a Leg Length Inequality Following Surgery. What Should I Tell Her?
Charles R. Clark, MD

Question 38

I Have a Patient Who Is 2 Weeks Postoperative From a Primary Total Hip Arthroplasty and the Wound Is Draining. What Should I Do?
Craig J. Della Valle, MD

Question 39

My Patient Has a Foot-Drop After Surgery. What Should I Do?
Marc M. DeHart, MD

Question 40

How Do You Manage the Patient With an Unexpectedly Positive Culture at the Time of a Revision Total Hip Arthroplasty?
Scott M. Sporer, MD

Section VIII: Failed General Questions

Question 41

I Performed a Hip Revision Using a 20-mm Extensively Coated Stem. At Her 5-Year Follow-Up Appointment She Is Asymptomatic but I See Severe Proximal Bone Loss. Do I Need to Do Anything?
Kevin B. Fricka, MD

Question 42

A 74-Year-Old Patient Has Failed Two Attempted Two-Stage Exchanges for Infection and Continues to Have Purulent Drainage From the Wound. When Do You Use Antibiotic Suppression and When Do You Perform a Resection Arthroplasty?
W. Randall Schultz, MD, MS and J. Todd Bagwell, MD

Question 43

I Have a Patient With Recurrent Hip Dislocation and I Think There Is Not Enough Anteversion in the Acetabular Component. How Can I Determine the Amount of Femoral and Acetabular Anteversion?
R. Stephen J. Burnett, MD, FRCS(C) and Robert L. Barrack, MD

Question 44

How Do You Evaluate a Patient With a Painful Total Hip Arthroplasty?
Alexander W. Siegmeth, MD, FRCS and Donald S. Garbuz, MD, FRCSC

Section IX: Failed Acetabulum Questions

Question 45

I Have a Patient Who Requires a Polyethylene Liner Revision and Has Minimal Anteversion in His or Her Component. What Surgical Approach Do You Use When Performing an Isolated Polyethylene Liner Exchange?

Question 46

I Have a Patient Who Has Recurrent Hip Instability and the Components Appear Well Fixed and in Appropriate Position. What Should I Do?
Devon D. Goetz, MD

Section X: Failed Femur Questions

Question 47

I Have a Patient With a Well-Fixed Extensively Porous-Coated Implant That Needs to Be Removed. How Do I Remove a Well-Fixed Extensively Coated Femoral Component Without Extensive Bone Loss?
Kenneth Kleist

Question 48

A Patient Fell and Now Has a Periprosthetic Femur Fracture With a Loose Femoral Component. How Should I Approach This Surgery?
Tad Gerlinger

Question 49

A Patient Fell and Now Has a Periprosthetic Femur Fracture With a Well-Fixed Femoral Component. How Should I Approach This Surgery?
Mark Dumonski, MD and Walter W. Virkus, MD

Index