Date: Tue, 18 Nov 2003 10:09:41 +0200
Subject: Gunshot wound of the right hip
Male, 26 y.o. Trauma at May 2003.
Ds: Gunshot wound of the right hip, open fracture of the right hip, gunshot wound of the abdomen. In urgent - laparotomy, debrigement of the wounds. Wound of the hip was repaired without complication. Immobilisation by cast till 3 months. No infection. We plan total cement arthroplasty. Another opinion? Features of the surgery and postoperative treatment?
dr. Anton Vladzymyrskyy
R&D Institute of Traumatology and Orthopedy
Date: Tue, 18 Nov 2003 10:56:27 -0600
From: Frederic B. Wilson, M.D.
In such a young man I would consider press fit, ingrowth components for both the acetabular and femoral side. Are they available to you?
Was there any thought given initially to trying to stabilize and salvage the femoral head?
Frederic B. Wilson, M.D.
Trauma & Adult Reconstruction
ETMC First Physicians - Orthopaedic Clinic
700 Olympic Plaza Circle, Suite 510
Tyler, TX, 75701
Date: Tue, 18 Nov 2003 18:00:30 -0000
From: Chris Wilson
Interested that you would go for uncemented femoral component. Why? Long term data on cemented tapered polished stem components hasn't been bettered, and uncemented are no easier to extract at revision.
Consultant Orthopaedic Surgeon
Date: Tue, 18 Nov 2003 11:09:52 -0500
From: Bill Burman
Don't forget about hip arthrodesis. Chandler JBJS 63A 1426 1981- loosening rate for hip arthroplasty - up to 57% in young patients. Consider hip arthroplasty later - if needed.
References for hip arthrodesis are below. It will be difficult to find better outcomes in the hip arthroplasty literature.
HIP ARTHRODESIS & THRA CONVERSION
JBJS 67A 1328 1985
avg follow-up - 35 yrs
Although 60% had ipsilateral knee pain, 60% had back pain and 25% had contralateral knee pain.
Only 1 patient was unemployed 2 to pain
70% could walk > 1 mile
70% were comfortable sitting more than 2 hours.
More back and ipsilateral knee pain with fusion in abduction vs. neutral or adduction.
6/6 conversions to THRA relieved back pain
2/4 conversions to THRA relieved knee pain
These findings were similar to Sponseller JBJS 66A 853 1984
5 - 15% rate of femur fx.
Back Pain not at a substantially different rate than the rest of the population.
Recommended position for fusion - 5 adduction, 35-40 flexion
JBJS 66A 853
Sponseller McBeath Madison Wisc
53 cases - 32 TB, 11 Septic, 4 SCFE, 3 CDH, 1 coxa vara
38 yr follow-up
43/53 working, 18% heavy labor
40% able to walk > 5 miles
32% moderate difficulty with sex, only one female felt a severe limitation.
57% with Low Back Pain - no radicular sxs, no incapacitating backache
( 60% of the normal population has low back pain)
Kettlekamp Score - avg ipsilateral avg contralateral 87 pts 91 pts.