TJA in Rare Conditions
Parsonage-Turner Syndrome and Closed-Incision Negative-Pressure Wound Therapy After Total Hip Arthroplasty in a Case of Marfan Syndrome
Negative pressure wound therapy (NPWT) is a postoperative wound care method, which has recently become an ongoing field of research in hip and knee arthroplasty. We report the successful management of wound dehiscence and infection after THA in a case of Marfan syndrome by closed-incision negative-pressure wound therapy (ciNPWT). Our patient also developed a rare postoperative neurologic complication, that is, Parsonage-Turner syndrome (PTS). To our knowledge, this is the first report of PTS and ciNPWT use for SSI after THA in a Marfan patient.Bilateral Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip and Extreme Hip Flexion Requirements due to Phocomelia
Phocomelia is a rare congenital birth defect marked by hypoplastic or markedly absent limbs. Developmental dysplasia of the hip (DDH) is a congenital disorder with a failure of the native acetabulum to provide complete coverage over the femoral head. The secondary osteoarthritis that develops from DDH is technically challenging for orthopedic surgeons because of distorted anatomy. The present case describes the diagnosis of Crowe 3 DDH in a phocomelia patient with hyperflexion requirements who successfully underwent staged bilateral total hip arthroplasty via a direct anterior approach.Spinopelvic Instability in Conversion Total Hip Arthroplasty: A Complicated Case of Loeys-Dietz Syndrome
A 53-year-old patient with a history of Loeys-Dietz syndrome (LDS) presented with cutout after a right femoral neck fracture treated with a dynamic hip screw. This was treated with conversion total hip arthroplasty (THA), the second reported THA in a patient with LDS and the first in a post-traumatic reconstruction setting. The patient had 2 episodes of posterior hip dislocations within 2 weeks after the operation requiring a revision THA utilizing dual-mobility bearing to achieve stability. LDS is a connective-tissue disorder that is associated with joint hypermobility and spinal deformities, among other features.Rapidly Progressive Osteoarthritis and Acetabular Bone Loss Outcomes for Patients Undergoing Primary Total Hip Replacement
Rapidly progressive osteoarthritis (RPO) is a rare condition which is poorly understood. Limited published literature is available. Reported here is a cohort of patients with RPO and acetabular bone loss who underwent primary THA. Risk factors, degree of acetabular bone loss and outcomes are presented. A typical case of RPO is described and investigations discussed. A retrospective audit was undertaken. 49 patients over an 18-year period were included. RPO patients were significantly older (P < 0.01) and had a lower BMI (P = 0.03).Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient
Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally.Femoral artery injury during total hip arthroplasty
There are an increasing number of vascular complications after hip replacement, some of which can be life-threatening. However, there are few reports of lower limb ischemic symptoms after undergoing an otherwise uncomplicated classic total hip replacement. We report a patient with low weight who developed postoperative limb ischemia resulting from blood clots caused by insertion of a Hohmann retractor close to small anterior acetabular osteophytes. Ultrasonography and angiography revealed her symptoms to be the result of femoral artery intimal injury with lower extremity arterial thrombosis, which led to pain, numbness, and decreased skin temperature.Concomitant achondroplasia and developmental dysplasia of the hip
Achondroplasia (ACH) is the most common form of hereditary dwarfism and presents with multiple musculoskeletal anomalies but is not normally associated with premature hip arthritis. Developmental dysplasia of the hip (DDH) is a spectrum of disease resulting in shallow acetabular depth and a propensity for chronic femoral subluxation or dislocation; it is among the most common causes of premature arthritis. This case report describes the diagnosis of symptomatic DDH in a patient with ACH and highlights difficulties of primary total hip arthroplasty (THA) as a treatment option.Arthroplasty in organ transplant patients
The number of solid organ transplants performed in the United States continues to increase annually as does survival after transplant. These unique patients are increasingly likely to present to arthroplasty surgeons for elective hip or knee replacement secondary to a vascular necrosis from chronic immunosuppression, or even age-related development of osteoarthritis. Transplant recipients have a well-documented increased risk of complications but also excellent pain relief and dramatic improvement in quality of life.
