PMC9343973_01
First radiographs of the patient. (A) AP view of the pelvic ring. We can notice the severe acetabular bone loss with pelvic discontinuity, classified as Paprosky IIIB. (B) Axial view of the left hip. We can observe the rupture of cerclage wiring and loosening of the femoral stem of his THA. We classified it as a type IV Paprosky femoral bone loss. AP, anterior-posterior; THA, total hip arthroplasty.
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We discovered a substantial prosthesis protrusion through a major pelvic discontinuity (Figure 3).
Coronal CT-scan views of the pelvic ring. (A) It showed a pelvic discontinuity of the medial wall of the left acetabulum, with prosthesis penetration of 5 cm, and a periprosthetic femoral osteolysis with additional cerclage wiring failure. Extended hematoma of the ilio-psoas and quadratus femoris muscles were also revealed. (B) CT-scan with contrast product injection, revealing no vascular compression or injury. It showed no active bleeding either. CT, computed tomography.
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Additionally, we carried out an injected computed tomography (CT)-scan which showed no vascular injury (Figure 4).
Postoperative radiographs after the first surgery. (A) AP view of the pelvic ring. (B) Axial view of the left hip. They showed an apparent satisfying equilibration of the femoral implant and a well orientation of the acetabular component within a well-centered femoral head. AP, anterior-posterior.
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Postoperative radiographs were satisfactory (Figure 5).
Postoperative wound aspect after the first surgery. Its evolution was uneventful. The staples were removed after 21 days.
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He presented an uneventful evolution, without wound issue (Figure 6), and with good progression on physiotherapy.
Radiographs at 6 weeks after the first surgery, showing a posterior dislocation of the left THA. (A) AP view of the left hip. (B) Axial view of the left hip. THA, total hip arthroplasty; AP, anterior-posterior.
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Radiographs confirmed a prosthesis dislocation (Figure 7), which was reduced under general anaesthesia.
Radiographs at 1 year after the last surgery. (A) AP view of the pelvis. (B) Axial view of the left hip. (C) AP view of the left femur. (D) Lateral view of the left femur. AP, anterior-posterior.
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Radiographs were satisfactory (Figure 8), we can notice adequate appearance of the THA and no sign of osteolysis or dislocation.