Conversion THA calls for an organized workflow, plans for hardware removal
A workflow with templating and multiple plans aids converting patients who underwent prior procedures for Legg-Calvé-Perthes disease or slipped capital femoral epiphysis or had femoral neck pinning to total hip arthroplasty, a speaker said.
In a symposium at the American Association of Hip and Knee Surgeons Annual Meeting, James A. Browne, MD, of the University of Virginia, said the outcomes of THA in these patients can be fairly good.
“The bottom line here is there is no strong evidence that outcomes or survivorship is compromised assuming you can technically perform the hip replacement appropriately,” he said.
Concerning a workup for infection as part of the workflow, Browne said to remember Bayes’ theorem of pretest probability to decide whether it is needed in this patient population. He used the example of a patient who is 40 years out from a slipped capital femoral epiphysis procedure and has never had an infection, saying that patient is not likely to be infected.
“These tests, in my opinion, should be used selectively based on the pretest probability of infection in that individual patient,” Browne said.
Leg length discrepancy can be an issue with this patient population, according to Browne.
“Always want to have multiple plans in place for these patients, particularly for issues like femoral version, which we may have a hard time determining preoperatively,” he said. “I think it is always wise to have the leg length discussion with these patients preoperatively in clinic as opposed to postoperatively in the [post-anesthesia care unit] PACU.”
Browne, who uses Coleman block testing to determine a patient’s subjective leg length discrepancy, said, “when in doubt, you want to under correct a little bit.”
“When it comes to the preoperative planning and templating, this is absolutely critical,” he said, noting such a workup can reveal acetabular issues that go beyond the femoral issues and retained hardware that may typically be expected.
“Always dislocate the hip before you take out the hardware,” Browne said.
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Browne JA. Prior SCFE, LCP and femoral neck pinning. What’s my workflow? Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 11-14, 2021; Dallas (hybrid meeting).
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