PMC6713042_01
Painful right hip with collapse of the femoral head due to avascular necrosis.
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F1
A 56-year-old patient had a complex primary THA following failure of fixation of an intertrochanteric fracture treated with a Gamma nail, 7 years ago (Figure 1).
A and B: Complex primary THA.
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F2
CoCr 36 + 10 femoral head was used and was found to be stable (Figure 2A and B). Clinical and radiographical follow up of his THA was unremarkable for 5 years postoperatively.
A and B: Proximal migration of the femoral head and radiolucent ring suggestive of polyethylene liner dissociation.
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F3
Careful evaluation of the radiographs showed that this radiolucency was consistent with a PLD (Figure 3A and B).
Intra operative picture showing the dissociated liner.
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F4
Intraoperatively, the acetabular liner was found to be dissociated (Figure 4).
Radiographs after revision of the acetabular components.
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F5
Trial reduction and range of movement testing were satisfactory, and hence the definitive components implanted included a Zimmer Continuum shell of size 64 mm with an offset liner and 36 mm + 12 Oxinium femoral head (Figure 5).
A and B: Constrained liner following the 2nd revision THA.
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F6
The polyethylene was revised and a constrained liner was used instead with a new size of 36 mm + 12 Oxinium femoral head (Figure 6A and B).