Total Hip Arthroplasty in a Patient with Crowe Type 4 Dysplasia , a Challenge for Orthopaedic Surgeons

Introduction: Total Hip Arthroplasty (THA) is a technically demanding procedure in patients with high hip dislocation due to both femoral and acetabular deformity, and morphologic abnormalities. Several problems and complications can be encountered, like nerve palsy, dislocation, non-union of the osteotomy site, peri-prosthetic infection, residual limp and periprosthetic fractures. We are presenting a long journey of a difficult case with dysplastic hip. Case presentation: A 54 year old woman who suffered from severe right hip pain, with dysplastic hip underwent a THA with subtrochanteric femoral shortening osteotomy. Postoperatively, at two months she fell down and suffered a Vancouver type B1 fracture. She underwent an open reduction and internal fixation procedure with plate, strut graft and cables. After the operation, the patient continued to suffer from pain and wound oozing. Irrigation and debridement was performed, but wound oozing carried on with the evidence of infection both clinical and laboratory results. This led to removal of all the implant, strut allografts, all devitalized bone fragment and instead, those were replaced with an antibiotic coated spacer. After three months, there was no clinical or serologic evidence of infection. Therefore, we performed a revision THA with grafting of fracture side and covered it with mash after removing the spacer. The distal femur was cemented to help stability and reinforcement. After two years, she had no pain and no sign of infection. The Harris hip score was improved from 38 to 85 at the last followup and she was mobilized fully without even a need for a walking aidwhich was the patient’s mobility requirement-level pre-operatively. Conclusion: Complex THA cases with dysplastic hips are difficult ones and require many technical considerations and a lot of experience. To improve the outcome, preoperative planning, proper implant selection and postoperative care are mandatory but, never without complications.