Curbside Consultation in Hip Arthroplasty: 49 Clinical Questions

Scott Sporer, MD

  • $99.95
  • ISBN 10 1-55642-830-8
  • ISBN 13 978-1-55642-830-2
  • 264 pp Soft Cover
  • Pub. Date: 2009
  • Order# 18308

Are you looking for concise, practical answers to those questions that are often left unanswered by traditional hip arthroplasty references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions? Curbside Consultation in Hip Arthroplasty: 49 Clinical Questions provides quick answers to the thorny questions most commonly posed during a “curbside consultation” between orthopedic surgical colleagues.

Dr. Scott Sporer has designed this unique reference which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with hip arthroplasty. The unique Q&A format provides quick access to current information related to hip arthroplasty with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the management of the hip.

Curbside Consultation in Hip Arthroplasty: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Practicing orthopedists, orthopedic residents, and non-physician personnel will benefit from the user-friendly and casual format and the expert advice contained within.

Some of the questions that are answered:

  • How do you treat a young patient with severe hip arthritis? When should they be indicated for surgery? What type of components should I use?
  • What should I do when I suspect a patient has an infected hip? When do I need to remove his/her prosthesis?
  • How do I treat a fracture of the femur when it occurs with surgery? Several years post-surgery?
  • What should I tell a patient that has persistent pain following a hip replacement and how should they be evaluated?
  • How can I determine the severity of acetabular and femoral bone loss? What should I do to reconstruct the deficient bone?

For a complete listing of all the books in the Curbside Consultation Series, please visit www.curbsideconsultations.com

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

"The editors have done a remarkable job of selecting a variety of challenges that make the read interesting and valuable. This is a valuable book in the series. I have always been honored by the time mentors and professors have spent with me in sharing their approaches to challenging problems. This format mimics that experience and makes the book fun, efficient, easy to read, and a valuable addition to your clinical repertoire."

— Mark R. Hutchinson, MD, University of Illinois at Chicago College of Medicine, Doody Enterprises, Inc.

Scott M. Sporer, MD is an orthopaedic total joint replacement surgeon in Chicago and holds an academic appointment at the rank of Assistant Professor at RUSH University Medical Center. He attended medical school at The University of Iowa before completing his orthopaedic residency training at Dartmouth Hitchcock Medical Center. He has completed a fellowship in adult reconstruction at RUSH Medical Center and currently has a clinical practice focusing on hip and knee arthroplasty. Dr. Sporer has a strong interest in clinical outcomes research and has completed a master’s program at Dartmouth College in the evaluative clinical sciences.

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