Gutiérrez-Jiménez René, Delgado-Cantú Felipe, González Rivera Carlos E, Monroy-Quiroz Alan, Pons-Faudoa Fernanda P
Traumatology and Orthopedics, Hospital San José de TecSalud, Monterrey, MEX.
Traumatology and Orthopedics, Hospital Christus Muguerza Alta Especialidad, Monterrey, MEX.
Cureus. 2024 Oct 15;16(10):e71557. doi: 10.7759/cureus.71557. eCollection 2024 Oct.
Aseptic loosening of femoral and acetabular components is a common complication following total hip arthroplasty (THA). It presents a significant diagnostic and therapeutic challenge for orthopedic surgeons, as it requires differentiation from infection and often necessitates complex revision surgery. We present the case of a 76-year-old female with a surgical history of total right hip arthroplasty performed one year prior. The patient presented with pain and limited mobility in the right lower extremity. Laboratory studies, including inflammatory markers and cultures, were negative for local or systemic infection. A biopsy of the right hip confirmed the absence of infection. Given these findings, a diagnosis of aseptic loosening was made. A revision right hip arthroplasty was undertaken, during which the acetabular component was found to be intact and was therefore retained. New femoral components were placed using an extended trochanteric osteotomy approach. Postoperatively, the patient demonstrated significant clinical improvement, regaining the ability to walk without support and exhibiting improved range of motion in the affected limb. Aseptic loosening of THA often requires revision surgery with component exchange to avoid any further complications that can increase morbidity and mortality. This produces a diagnostic and therapeutic challenge for the orthopedic surgeon due to the difficulty of cement retraction, previous implants, and the placement of new prosthetic components. Extended trochanteric osteotomy is an excellent tool for the orthopedic surgeon facing a revision of THA to remove the cement mantle and femoral stem and avoid complications.
股骨和髋臼假体的无菌性松动是全髋关节置换术（THA）后常见的并发症。这给骨科医生带来了重大的诊断和治疗挑战，因为需要将其与感染相鉴别，且往往需要进行复杂的翻修手术。我们报告一例76岁女性患者，其在一年前接受了右侧全髋关节置换术。患者出现右下肢疼痛和活动受限。包括炎症标志物和培养在内的实验室检查结果显示，局部或全身感染均为阴性。对右髋关节进行活检，证实无感染。基于这些发现，诊断为无菌性松动。遂进行了右侧髋关节翻修术，术中发现髋臼假体完好，因此予以保留。采用大转子延长截骨术放置了新的股骨假体。术后，患者临床症状显著改善，恢复了独立行走能力，患侧肢体活动范围也有所改善。THA的无菌性松动通常需要进行假体置换的翻修手术，以避免任何可能增加发病率和死亡率的进一步并发症。由于骨水泥取出困难、存在既往植入物以及新假体组件的放置问题，这给骨科医生带来了诊断和治疗上的挑战。大转子延长截骨术对于面临THA翻修的骨科医生来说是一种很好的工具，可以去除骨水泥壳和股骨干，避免并发症。
