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CASE 1: ACETABULAR DEFICIENCY AFTER TRAUMA & INFECTION

Pre-operative Management:

This 47 year old female was involved in a high speed MVA and suffered an injury to her R hip.

1977: MVA. No specific treatment. DJD develops.

1979: Femoral head resurfacing arthroplasty (Fig 1) Note thin polyethylene shell.

1988: Conversion to R THA (Fig 2), Acetabular reconstruction and posterior column plating for pelvic discontinuity.

1991: Liner change for pain.

Jan. 1997: Revision THA, Acetabular reinforcement caqe (Fig 3) and structural allografting for loosening, protrusio, medial cavitary deficiency, probable segmental anterior column bone loss, posterior wall bone loss.

Figure 1	Figure 2	Figure 3

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Sept. 97: Infection (Fig 4) develops one month post -operatively. Cup spacer placed.

Dec. 97: Referred to our clinic, all components are removed. Spacer placed. Antibiotic regimen begun.

Feb. 98: Spacer removed. Antibiotic regimen ended. She was then monitored in clinic for the next several months.

Aug. 98: Pre-op Xray (Fig 5). All infection parameters appeared normal (ESR, aspirations). Her main complaint was her nonfunctional Girdlestone, unstable hip and shortened R leg. She was unable to ambulate without crutches. She wanted to attempt another reconstruction. She appeared to have a Type III-B acetabular defect (Paprosky).

Figure 4	Figure 5

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