This document discusses a case report of a failed subtrochanteric shortening osteotomy in a 36-year-old female patient. It provides details of her surgical history including multiple prior hip surgeries. The reasons for failure of her current implant are discussed, including that sleeves do not work well in tubular bone and mismatches in proximal and distal femur. Pre-operative workup to rule out infection is outlined. Options for revision surgery including acetabular component retention or revision and choices for distal fitting femoral stems are presented.

1. Choice of distal fitting femoral revision stem in a case of Failed Sub
Trochanteric Shortening Osteotomy - A case report.

2. CLINICAL HISTORY
36 female - complex THR – 2011
(age28)
℅ Painful hip - 3 years - 2015 (age 32)
Difficulty in walking - 2 years- 2016
Noisy Hip
LLD +

3. (surgery 1) 2007 Hip Arthrodesis (age 24)
( surgery 2 ) 2008 Excision arthroplasty - ? Infection (age 25)
(surgery 3 ) 09.6.2011 Right complex THR -STSO –S Rom (age 28)
(surgery 4 ) 24.6.2011 Dislocation - Reduction + Plating
Some xray – missing
H/O ? Right Hip injury
at 7 years of age
managed conservatively

5. WHY it Failed ?
• Sleeve doesn’t works in tubular bone
• S-Rom doesn’t works in femur with Proximal distal mismatch
• Rotational stability of cone sleeve always to be checked

7. Rule out Infection
ESR 27
CRP 1.19
Investigate thoroughly

8. Implant Stability / Positioning ?
● Serial x- ray
● Bone scan – uptake
● Ischiolateral view
● CT scan

9. Surgical Approach

10. Stable acetabular socket
Retain the cup if stability is good
10* Hooded poly is a constraint device
Stable acetabular socket with poor abductors
Dual mobility as backup
If unstable acetabular socket – revision of cup

11. monoblock
Vs
modular
distal fitting stem
Wagner starts @ 14mm (min 9mm) – Peterbraun starts @ 13mm (min 8mm) – Redapt starts @ 12mm (min 7 mm) - solution starts@ @
SRom 9 stem 14 sleeve
Curved
vs
Straight

14. Sratch fit

15. Take Home Message - AJRI - MOS
Diagnosis – proper history
Serial x ray , bone scan (Bone quality , Bone loss )
Rule out infection preoperative blood markers , Intraoperative culture
Implant choice – patient specific – Age , Sex , ethnic
Revision options - Constrained ++ options for backup
Wagner Scratch fit– min 2.5cm

16. THANKS