Revision Total Hip Arthroplasty

Eric L. Smith MD, FAAOS, FAAHKS, FAOABenjamin E. Bierbaum ChairmanDepartment of OrthopaedicsNew England Baptist HospitalProfessor of OrthopaedicsTufts University School of Medicine125 Parker Hill AveBoston, MA 02120617-754-5413 James V. Bono, MD Clinical Professor of Orthopaedic SurgeryTufts University School of MedicineBoston, MA Vice Chair, OrthopaedicsRoderick H. Turner Distinguished Professor of Hip & Knee ArthroplastyNew England Baptist HospitalBoston, MA

• Part I. Generalized Principles in Revision THA.- Revision burden-projections in US and world-wide.- Soft tissue balancing/biomechanics.- Reconstruction of femoral defects- ETO, tapered modular stem, mega prosthesis.- Reconstruction of Acetabular defects- augments, bone graft, cup, cages.- Consideration of biomaterials (ceramics, corrosion, cement).- Basic science of THA failure.- Part II. Evaluation of the Painful Total Hip Arthroplasty (PTHA).- History and Physical, laboratory, injections.- Radiographic evaluation of the PTHA.- Hip-spine evaluation.- Special medical considerations (RSD, MS, cervical stenosis, Neurological).- Part III. Preoperative Planning.- Acetabular evaluation and classification of failure.- Femoral evaluation and classification of failure.- The patient evaluation and optimization of modifiable risk factors before revision THA.- Blood/fluid and Anesthesia.- Bone graft and bone substitutes.- Implant inventory-general (stem choices, acetabular choices) and Specialized Equipment -long chapter.- Part IV. Surgical Approaches/exposure.- Posterolateral.- Extended Trochanteric Osteotomy.- Direct anterior.- Direct anterior (Naylor).- Anterior based osteotomies.- Direct lateral.- Trochanteric slide osteotomy.- Anterolateral.- Tap out-tap in technique.- Removal of Well-fixed acetabular components.- Removal of well-fixed femoral components.- Part V. Acetabular reconstruction techniques.- Landmarks to determine anatomic hip center of rotation.- Hemispherical cup.- Augments.- Buttress.- Cup/cage.- Cage.- Custom triflange.- Pelvic discontinuity techniques.- Structural allografts.- Part VI. Femoral Reconstruction techniques.- Tapered modular stems.- Proximal porous modular stems.- Non-modular stems (Wedge or HA coated).- Fully porous stems.- Calcar replacement stems.- Articulated Antibiotic cement spacer.- Non-articulated antibiotic cement spacer/resection arthroplasty.- Proximal femoral replacement.- Total femoral replacement.- Cemented stems.- Impaction grafting.- APC.- Part VII. Trochanteric reconstruction techniques.- Short Plate, Long plate, Wires/sutures.- Part VIII. Surgical Techniques in Revision Total Hip Arthroplasty: Authors preferred techniques.- Instability.- Aseptic Loosening.- Infection.- Periprosthetic fracture.- Corrosion.- Implant Failure/Implant Fracture.- Osteolysis.- Use of Mega-prosthesis/total femur.- Use of Cages and custom triflanges.- Part IX. Minimizing complications after Revision THA.- Neurological Injury.- Thigh pain.- Vascular injury.- Postoperative Infection.- Instability.- VTE.- Wound Complications.- Part X. Revision THA: Unique surgical considerations.- Complex THA after previous surgeries.- Complex THA after Acetabular fracture.- Abductor tears, soft-tissue impingement, iliopsoas, rectus.- HO.- Combined abdominal and pelvic approaches.- Revision THA for LLD.- Conversion of Girdlestone arthroplasty to THA.- Conversion of hip arthrodesis to THA.- Metastatic Disease of the Hip.- Part XI. Special considerations with Revision THA.- Performing revision THA in ASC’s.- Using current data and research to drive decision-making.- Evaluating Outcomes in Revision THA.- Considering malpractice in revision THA.- The role of physical therapy in revision THA.- Maximizing efficiency in revision THA (hospital and personnel).- Financial implications of revision THA (surgeon and hospital).