Case report

This lady underwent the first hip replacement 24 years ago for a hip fraction. A total hip replacement was done but left the leg shorter as the hip was cited high above the center of rotation by the surgeon. She managed for twenty four years but this hip began to fail and she was unable to walk by the middle of 2014.

She underwent a revision hip replacement in a city hospital in June 2014. But again the surgeon failed to recognize that the previous hip was positioned abnormally. He repeated the same mistake of placing the socket way above the normal center of rotation. Additionally, years of plastic wear and an erroneous revision surgery had left a gaping hole in her pelvis. The revision hip replacement that had the twin problems of abnormal position and lack of bone support.

The result was that this elderly but highly motivated lady was bedridden for three months after the second hip operation in June 2014.

Her case was shown to many doctors in the city but all refused to intervene and suggested to the family members that the lady be bound to a wheel-chair for the rest of her life.

This was unacceptable to her US based daughters. Despite the previous two failed hip replacements, the family was convinced that the elderly lady had nothing to lose by another attempt to restore her mobility.

Analysis of the x rays and additional 3 D CT scans indicated that there was gross bony deficiency in the left half of the pelvis and the socket was mal-positioned.The surgeon developed a pre-operative plan based on his analysis. He implemented the procedure arduously. He reconstructed the hip with the help of allograft bone and implants made of a special material known as Trabecular metal. This material allows ingrowth of host bone into it quickly.

The operation was a success.

After three months of recumbency and physical therapy, this lady is able to walk again.

Re revision hip replacements are very rare as most patients do not live very long after a first hip replacement. Even if it is required, most people are scared to get their elderly parents be operated in old age. It is also rare to find patients sufficiently motivated to undergo a heroic surgery and heactic rehabilitation process. This charming lady had the courage and confidence to go through a third hip replacement and the result is a new lease of mobility and life.