Particularities of hip arthroplasty in bilateral diseases of the hip joint (case study)

Abstract

The aim of the study: Appreciation of the tactics and secventionality of the surgical treatment strategy of hip arthroplasty in severe disorders of both hip joints. Materials and methods: We report a case of a male patient of 61-year-old who came in 2010 in the clinic for hip arthroplasty, having a diagnosis right posttraumatic coxarthrosis, hip ankylosis and vicious consolidation of the subtrochanteric femur fracture on the left side, paralytic equinus valgus foot, statics and gait disorders. In 1985, as a result of a vehicle accident, he suffered a fracture of acetabulum and posterior dislocation of the femural head on the left side. It was applied the tibial skeletal traction for one month, after then was made the arthrodesis of the left hip joint. Four years later, as a result of an another vehicle accident, he suffered a fracture-dislocation of the right femur and a subtrochanteric fracture of the left femur, that was open reduced with ostheosynthesis with Kuncher centromedular nail. For the fracture-luxation of the right femur was applied the skeletal traction for eight weeks. As a first step was made the subtrochanteric corrective osteotomy on the left femur and ostheosynthesis with DCS and after eleven weeks was made total arthroplasty of the right hip joint. Intraoperative was found the pseudoarthrosis of the posterior-superior acetabular wall. The unconsolidated fragment was removed and the autoostheoplasty of the defect with bone graft from the femoral head was done. The postoperative evolution was normal, patient initiated partial support after 2 months and total to 16 months. Result: Six months after the last surgical intervention the clinical and radiological evolution is favorable. The patient is satisfied with his functional results, having a Harris score of 69 points on the left side and 92 points on the right side after 4 years of hip arthtroplasty. Conclusion: For obtaining good and long-drawn results in the treatment of bilateral hip joints disorders, it is necessary to correct the important deformities and to restore the biomechanics of the pelvis and hip joints.