Case #2 - Custom Total Hip Arthroplasty

Matthew J. Kraay, M.S., M.D.
Assistant Professor Orthopaedic Surgery, Case Western Reserve University School of Medicine Director, Division of Joint Reconstruction and Arthritis Surgery, University Hospitals of Cleveland

(Note: You can click on any of the pictures to see a larger version.)

The patient is a 55 year old male with several year history of progressively increasing left hip pain (Figures 1&2). There is no history of any trauma other than arthritic complaints. The patient has had a thorough trial of non-operative treatment. He had pain at night and could only walk for 10 minutes at most without having significant pain. His preoperative Harris hip score was 47.



Physical examination showed an antalgic gait with a prominent abductor Lurch. He had flexion of the hip to 110°, extension to 0°, abduction to 25°, adduction to 10°. His internal rotation was limited to 0°, external rotation to 10°. His leg lengths appear equal clinically.

Preoperative X-rays demonstrated excellent bone quality with very narrow diaphyseal canal and a relatively wide metaphysis with advanced osteoarthrosis of the hip (Figures 3-5).



Image data shows cortical bone density represented by white 300-750, red 751-1350, and blue 1351-2000 hounsfield units (Figures 6, 7).



Figure 8 indicates that the acetabular socket is does not require a custom and can be implanted with a standard hemispherical cup.



In view of his young age and diaphyseal/metaphyseal geometry a custom total hip arthroplasty was recommended. Figures 9 and 10 show the proposed implant design in A/P and lateral views.



The proposed design achieves intimate cortical contact with the anterior and medial metaphyseal surfaces (Figure 11).



Figure 12 shows the implant design transposed with condylar and proximal femoral data to show that the patient's anteversion was duplicated.



The patient was taken to surgery on 2-24-98 at which time the porous coated uncemented femoral component was inserted with a ceramic femoral head. Excellent intraoperative stability and restoration of leg length was achieved without fracture or complication (Figure 13). The patient's postoperative course was uneventful.