PMC6588156_01
X-ray (a) anteroposterior and (b) lateral view before endoprosthesis implantation. An atrophic pseudarthrosis with a bone block from a previous surgery can be seen as well as implant failure.
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F1
The trochanter major was not apparent due to a non-union after femoral valgisation (Fig. 1).
(a) Intraoperative photo of the femoral head with pseudarthrosis and arthritic bone formation of the femoral head,(b) intraoperative fluoroscopy imaging demonstrating the placement of the acetabular reinforcement ring, (c) as well the Ecofit cup 2M (dual-articulation acetabular cup system), and (d) Wagner cone stem.
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F2
Wagner cone stem with distal fixation which is not designated for this kind of stem but for revision stem shaft types. We achieved an adequate hip stability in this specific case using an acetabular reinforcement ring (Zimmer, Warsaw, IN, US) with a cemented Ecofit cup 2M, and acetabular bipolar cup system (Implant cast GmbH, Germany) (Fig. 2 and 3). Due to the poor bone quality, we reinforced the acetabular component with screws (Fig. 2 and 3).
Post-operative X-ray (a) anteroposterior and (b) lateral view showing no bone formation at the side of the greater trochanter on the left side where the abductor muscle group was sutured to an attachment tube.
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F3
Wagner cone stem with distal fixation which is not designated for this kind of stem but for revision stem shaft types. We achieved an adequate hip stability in this specific case using an acetabular reinforcement ring (Zimmer, Warsaw, IN, US) with a cemented Ecofit cup 2M, and acetabular bipolar cup system (Implant cast GmbH, Germany) (Fig. 2 and 3). Due to the poor bone quality, we reinforced the acetabular component with screws (Fig. 2 and 3).
(a)Follow-up X-ray 4.5 years after implantation demonstrates new ossified bone tissue at the region of expected greater trochanter. (b) the patient was able to perform one leg stand without support and any sign of Trendelenburg.
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F4
Weight-bearing and hip flexion were stepwise increased during follow-up time, and the patient was able to walk without crutches and no sign of Trendelenburg 2 years after total hip arthroplasty (Figure 4). X-rays revealed no signs of loosening or migration during the entire follow-up time (Fig. 4).