PMC6727449_01
The dermatological manifestations on the elbow (a) and hand (b) of the patient recorded in a pre-operative clinical visit.
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F1
Her dermatological symptoms included an intermittent, disseminated, and pruritic facial, hand, and arm rash that worsened with sun exposure and consisted of erythematous papules coalescing into plaques (Fig. 1a and b).
Pre-operative radiographs showed osteolysis at the medial calcar, greater trochanter, and the proximal femoral diaphysis.
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F2
Radiographs obtained demonstrated osteolysis at the medial calcar, greater trochanter, and the proximal femoral diaphysis (Fig. 2).
Pre-operative bone scan demonstrating increased activity in the peritrochanteric region of the proximal femur.
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F3
Bone scan showed activity in the peritrochanteric region of the femur (Fig. 3).
Intraoperative images demonstrate metallosis and evidence of trunnionosis. The approach to the implant (a), operative view of head and tissue around it (b), inspection of the neck showing trunnion wear with a black discoloration at the tip of the taper (c), and explanted femoral implant, head, and liner (d) are all shown.
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F4
The hip was approached through the previous posterior approach (Fig. 4a) which was lengthened distally to allow full access to the femur to perform an extended trochanteric osteotomy (ETO). After the hip was exposed and the prosthetic head disengaged, clear evidence of metallosis was encountered at the trunnion (Fig. 4b and c). The stem was removed with minimal bone loss (Fig. 4d).
Anterior-posterior (a) and lateral (b) post-operative radiographs with Stryker Restoration femoral component.
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F5
The hip was revised utilizing a Stryker Restoration (Stryker Inc., Kalamazoo, Michigan) revision stem (Fig. 5a and b).
The patient presents for her 3-month follow-up visit demonstrating full resolution of her dermatological manifestations.
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F6
By her 2-month follow-up visit, she reported complete resolution of her skin rash (Fig. 6).