PMC5985256_01
Pelvic Anterior-Posterior radiograph of patient at index presentation (2 years post-primary THA) demonstrate Bilateral THAs with acceptable component positioning, stable asymptomatic fixation and normal bone quality.
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Radiographic images taken at the time of initial presentation showed implants in acceptable position with no evidence of implant, loosening, subsidence, or fracture (Fig. 1).
Pelvic Anterior-Posterior radiograph of patient at 30 months status post-Primary THAs. Note the medial wall thinning of the acetabulum and subsidence on the left side and increased cup inclination on the right.
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The left hip exhibited an attenuated medial acetabular wall and significant medial cup migration with increasing cup anteversion and inclination (Fig. 2).
Pelvic AP radiograph and Frog-lateral of the left hip 33 months status post bilateral primary THA. There is further loosening of the right acetabular component with an inclination of almost 90  and medial migration of the acetabular cup. Further left sided acetabular component migration with intra-pelvic protrusio and suspected pelvic discontinuity.
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Radiographic images (Fig. 3) exhibited an acute progression of the left acetabular component with cup protrusio and further loss of the medial wall.
Pelvic AP radiograph and Frog-lateral of the left hip status post left hip explant and placement of a static antibiotic cement spacer. A Hickman's catheter was placed for intra-articular antibiotic delivery.
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Intraoperatively, she was found to have a Paprosky type IIIB acetabular defect and pelvic discontinuity with Paprosky Type II proximal femoral deficiency with extensive metaphyseal bone loss and intact diaphysis (Fig. 4).
AP pelvic radiograph status post Right hip Acetabular component revision for aseptic loosening. Note the superior trabecular metal augment fixed with screws for a Paprosky Type IIB acetabular defect.
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Type IIB superior lateral acetabular deficiency (Fig. 5) (Zimmer, Warsaw, IN; Continuum 56 mm multihole trabecular metal revision shell with a 40 mm cemented Continuum liner, 50 mm x 10 mm oblong augment with a 40 mm + 0 cobalt chrome head).
Pelvic AP radiograph and AP of the left hip status post left sided THA replant with a "Cup-in-Cup" construct, Trabecular metal augment, dual-mobility head, and a distal fixation modular cementless femoral revision stem.
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Femoral reconstruction was achieved via a distal fixation noncemented modular revision stem (Arcos STS Stem), Size C, 60 mm proximal cone body (Biomet Co, Warsaw, IN) and supplemented with one stainless steel cable (Accord, Smith and Nephew Memphis, TN) (Fig. 6).
Pelvic AP radiograph and AP of the left hip 1-year status post left hip revision THA. Note the complete graft incorporation and stable bone-implant osseointegration, with no signs of loosening/osteolysis/graft resorption.
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At her 1-year outpatient follow up, the patient was ambulating independently without the use of an assistive device and had painless, complete range of motion with no significant post-operative sequelae. 1-year postoperative radiographs showed continued acceptable position of bilateral hip implants with no evidence of subsidence, loosening, or fracture (Fig. 7).