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Fig. 7 | BMC Musculoskeletal Disorders

Fig. 7

From: Diagnosis, preoperative evaluation, classification and total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis

Fig. 7

A typical case to show the diagnosis, preoperative evaluation, and surgical procedure of total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis. This was a 56-year-old female with a complaint of pain in both hips for the past several years. In the most recent 6 months, the patients felt that the aggressive pain increased, especially in the right hip. The pain was described as severe and radiating down the anteromedial thigh regions from the bilateral hips. The patient walked with severe claudication that sometimes necessitated using a cane. She had a history of rheumatoid arthritis and had received systemic steroid treatment. She also reported a previous “pelvic fracture” occurring 23 years ago. a Plain radiographs of the pelvis revealed rheumatoid arthritis of the right hip and “osteoarthritis” of the left hip (the aureole sign could be identified). An old pelvic fracture was also identified from the plain radiographs. According to the findings on plain radiographs of the pelvis, the patient was initially diagnosed with “rheumatoid arthritis (right hip) and osteoarthritis (left hip)” and an “old pelvic fracture”. b From the axial image of the CT scan, it was identified that the pseudoacetabulum was in retroversion, with subdislocation of the femoral head (the rhombus sign could be identified). c On 3D reconstruction of the CT scan, the dislocation of the hip joint was identified, as was the correct position of the original acetabulum. d The model of 3D printing clearly showed the pseudoacetabulum. The original acetabulum was also identified. e Computer simulation demonstrated that the acetabular component could be implanted on the original acetabulum without bone deficiency. f This intraoperative photograph shows the pseudoacetabulum near the original acetabulum, which resembled the Arabic numeral “8”. g The original acetabulum was reamed by an acetabular reamer of 40 mm diameter. h An acetabular cup was implanted successfully. i The femoral component was implanted successfully. j The pseudoacetabular wall (osteophyte) was removed; therefore, the muscle tension of the gluteus medius (and gluteus minimus) decreased. The joint prosthesis could be more easily reduced without proximal femoral osteotomy. k The joint was reduced successfully. The acetabular cup was well covered without bone deficiency. The pseudoacetabulum could be seen clearly. l Intraoperative fluoroscopy showed a good position of the prosthesis. The postoperative radiological examination is shown in Fig. 6c

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