T. M. O., d. o. b. 18.12.1971 - Sickle cell anhaemia
Post-operative check X-Ray picture. Considering the short life expectancy of sicklers and their tendency to develop bone infections, an MS-30 cemented pros-thesis was chosen together with gentamycin cement. The acetabular cup was a Robert Mathys, metal-on-metal uncemented one.
THE HEAD REMOVED FROM THE LEFT SIDE WAS KEPT DEEP FROZEN AND USED TO CREATE AN ACETABULR ROOF THE RIGHT SIDE * *
PREOPERATIVE PLAN * * Graft from the preserved head of the other side
AT THE OPERATION, THE FEMORAL SHAFT COULD NOT BE PULLED DISTALLY, SO THE GRAFT TO REBUILD THE ACETABULAR ROOF WAS FIXED WITH SCREWS AND A TRACTION WAS APPLIED .
AFTER ONE MONTH TRACTION THE PROSTHESIS COULD BE FINALLY INSERTED ON THE RIGHT SIDE.
SECONDARY LOOSENING AND INFECTION AFTER AN ACCIDENT
23.09.2008 (From Dr. Byakika)
Recently Tom presented to me with a painful right hip especially in the upper thigh area for a duration of about 5/12, after an accident. On examination there was a small purulent, discharging sinus over the upper mid thigh junction laterally and the area was quite tender. His C-Reactive protein was raised > 30.
The X-rays that I send to you are self explanatory, with the stem perforating the lateral cortex and showing osteoporosis. The acetabulum seems fine. The main problems are the sepsis and a perisprosthetic fracture, with osteoporosis.
I consider that he would benefit from a 2 staged revision, first to remove the femoral stem, eradicate sepsis and second insertion of a revision stem.