Metal on Metal Revision Hip Surgery by Dr Anoop Jhurani

Description

This video depicts a surgical case involving a 60-year-old male patient who experienced complications after receiving a metal-on-metal total hip implant. Initially, the patient reported reasonable post-operative outcomes, but developed severe symptoms including pain, limping, recurrent dislocations, and instability after two years. Radiological assessments showed flaws in the implant positioning, including a poorly seated cup and a varus-stem alignment. The revision surgery involved comprehensive preoperative planning, utilizing a Mars MRI to evaluate potential pseudo tumor formation which was found to be destroying the abductor muscles and greater trochanter, contributing to the instability.



During surgery, a standard posterior approach was employed to address the existing metal cup, requiring meticulous removal of well-ingrown components, with efforts taken to prevent excessive bone loss. The revised procedure included the implantation of a modular restoration-type stem, which was tailored to the patient’s anatomy including separately preparing the metaphysis and diaphysis to accommodate for prior stem removal. Specialized techniques such as the careful application of curved osteotomes for gradual cup extraction were showcased.



Post-surgery, the patient achieved significant improvements, with no pain or instability, and functional hip movements restored. The video also highlights the process for handling complications from pseudo tumors, extensive preparation for compatibility of new implants, and the importance of a stable fixation to support recovery. Results from the surgery include a successful restoration of hip function and confirmation of stability through various clinical tests conducted on the patient.

DOI: 10.1302/3114-240512

Specialties