mylesclough at shaw
New User
Feb 27, 2008, 11:14 AM
Post #1 of 1
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[Orthopod] Re: continuing failed dhs series
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It looks as though the tip of the screw impinges against the side of
the acetabulum. Therefore the joint may be relatively undamaged and
painless. Adduction/Abduction views might document that. You could
try plain tomograms or CT if there is a suggestion that the joint is
damaged. You can often get good CT images even with interference from
the metal. If the joint is badly eroded you and the patient face a
nasty choice about THR as removal of the metal may not be enough. The
main issue apart from the economic one, would be cooperation with
post operative restrictions.
Even in the circumstances of alcoholism (and myeloma!), I would be
inclined to offer him removal of the screw for pain relief and a shoe
build-up to even up his gait. If the pain relief is not sufficient
then he would have to demonstrate he can stay sober for 3 months
before I would take treatment further. Not that I haven't frequently
done THR on alcoholics (known and unknown) :-)
Myles Clough MD FRCSC
Orthopaedic Surgeon, Retired
Kamloops, BC
mylesclough@shaw.ca
Clinical Instructor, University of British Columbia
Associate Editor, Orthogate www.orthogate.org
Editor, Orthopaedic Web Links (OWL) www.orthopaedicweblinks.com
On 27-Feb-08, at 9:48 AM, Dr Neeraj Bijlani wrote:
> Hello,
> I would like to present to the house one more case 70 year old male
> patient chronic alcoholic cam to me with back pain, on clinical
> examination i found out that he has shortened right lower limb in
> external rotation on further enquiry, i came to know that he was
> operated 5-6 years back in some charitable hospital and has not
> been able to walk without support since then. He is now walking
> with crutches has backache since 10-12 days and xrays of thehip
> shows this failed dhs but the fracture has united inspite of
> implant cutout.
> Xrya of spine shows osteoporotic compression fracture at l3 level,
> I am investigating for multiple myeloma.
>
> I would like to have a opinion of the house as to
> whether implant removal will help him walk without support and shoe
> raise
>
> Awaiting Reply.
>
> Dr Neeraj Bijlani
>
> >
> <27022008254.jpg><27022008253.jpg>
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