Date: Sun, 14 Mar 2004 00:43:07 +0530

Subject: Thigh pain after hip hemiarthroplasty

From: tigeorge

Friends,

Presenting this case for your opinion. Elderly lady who underwent hemi hip replacement about one month back presented with thigh pain at rest. Had a respiratory infection during this visit which responded to treatment. Able to walk without pain with the help of walker. Hip movements not associated with pain. No local evidence of infection. During surgery the prosthesis stem had the occassional Indian problem of too big a stem for this patient's femur though the head size was okay.However it was succefully inserted without any fracture. Patient ambulated from second post op day. Her main complaint pain at rest in the thigh. Thanks in advance for your opinions.

Dr. T. I.George
Head of Ortho Unit III
Little Flower Hospital
Angamaly, India


Reply at: Orthopaedic Trauma Association forum

Date: Sun, 14 Mar 2004 09:04:17 +0200

From: Y. Ates

Cemented or uncemented?

Yalim Ates MD


Date: Sun, 14 Mar 2004 18:01:34 +0530

From: tigeorge

It is an uncemented Austin Moore prosthesis.

tigeorge


Date: Mon, 15 Mar 2004 05:00:07 EST

From: Aobonedoc

Rule out infection. Was is a cemented or uncemented hemiarthroplasty implant?

Looks uncemented. Rule out infection. If not infected, live with for a reasonable period of time and if not better revise to cemented implant.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005


Date: Mon, 15 Mar 2004 07:46:58 -0500

From: James Carr

It looks like a Thompson prosthesis, which was intended for cemented use. Aspirate her hip, revise to cemented regular total hip stem +/- acetabular cup.

Jim Carr


Date: Mon, 15 Mar 2004 16:12:55 -0000

From: Niraj L Vora

> It looks like a Thompson prosthesis, which was intended for cemented use.

Didn't Thompson invent his prosthesis before Charnley came up with bone cement???

Niraj L Vora
Orthopaedic Surgeon
Prescot, UK


Date: Mon, 15 Mar 2004 22:43:34 +0530

From: rajesh

He did and in his original paper he attributes the stability to the shape of the stem and the engineering,not cement !(not yet invented anyway !!)

Dr.K.R.Rajesh,MS,DipNB,FRCS,FRCS(Orth)
Consultant Orthopaedic surgeon
Lords Hospital & Cosmopolitan Hospital
Trivandrum, India.


Date: Mon, 15 Mar 2004 12:32:11 -0500

From: James Carr

I don't know the history/sequence. I do know our training "dogma" was the Thompson was for cemented use.

Jim Carr


Date: Mon, 15 Mar 2004 19:44:55 +0200

From: Y. Ates

I think the prostheisis is An Austin Moore type. Not a Thompson. Moore type prosthesis is intended for cementless use but it is sometimes implanted with cement.

Yalim Ates MD


Date: Mon, 15 Mar 2004 21:27:31 +0530

From: tigeorge

I thought I answered this querry before. It is an uncemented Austin Moore prosthesis made by one of the leading Indian implant manufacturer.

Dr.T. I. George.


Date: Mon, 15 Mar 2004 14:57:45 -0500

From: James Carr

I stand corrected. Thanks

Jim


Date: Tue, 16 Mar 2004 07:01:55 EST

From: Aobonedoc

I also thought this looked like an Austin Moore although I have not seen one for 10 years.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005


Date: Tue, 16 Mar 2004 20:18:39 +0530

From: tigeorge

Out of ignorance, which is the prosthesis of choice for the elderly with fracture neck of femur in your settings? What is your protocol for the elderly with this problem? Hemi/ thr?

Dr.T. I. George.


Date: Wed, 17 Mar 2004 21:38:32 EST

From: Aobonedoc

I cement a bipolar and I bet almost any stemtoday will do. I use a bipolar out of hope that it is less likley to dislocate although the data does not really support this reason. Monopolar head would work well. I cement for immediate fixation but a poster at last weeks academy meeting found press fit HA coated did better than cemented in older (75 and over) osteoporotic patients. I do not plan to change for now.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005