Complex Hip Replacement: Challenges and Solutions for Patients

Complex Hip Replacement

Hello, doctor.
I am from Taiwan, and my patient is my girlfriend, who is 24 years old and from Mainland China.
She was diagnosed with avascular necrosis of the left femoral head due to a car accident at the age of 12.
The surgical procedure at that time is unknown.
Since then, she has been experiencing a limp with a leg length discrepancy of about 5 to 6 cm.
This year, she sought medical assistance at several tertiary hospitals in Beijing, where X-rays revealed a high dislocation of the left femoral head that is not within the true acetabulum.
The doctors in Beijing recommended hip joint replacement but mentioned that to avoid nerve and vascular damage, while the hip joint replacement could lengthen the lower limb, they could not guarantee equal leg length.
If equal length is not achieved, a subsequent limb lengthening procedure would be necessary.
My girlfriend has visited many hospitals in Beijing but has not received any guarantees for restoring equal leg length.
Hearing about the high standard of medical care in Taiwan, she plans to come to Taiwan for international medical treatment.
Based on Taiwan's experience and standards, is it possible during hip joint replacement surgery to achieve a lengthening of 5 to 6 cm through soft tissue release and hip joint reduction? Is this type of surgery feasible at any general medical center in Taiwan? Thank you for your time and response!

Mr. Lin, 30~39 year old female. Ask Date: 2012/03/21

Dr. Shi Guozheng reply Orthopedics

Surgery is possible, but it is more challenging and carries the risk of damaging the sciatic nerve.
Larger medical centers have the capability to perform this type of surgery.

Reply Date: 2012/03/21

More Info

Complex hip replacement surgeries, particularly in young patients with a history of avascular necrosis or significant deformities, present unique challenges and require careful consideration of both surgical techniques and postoperative rehabilitation. Your girlfriend's situation, with a history of left femoral head necrosis and a significant limb length discrepancy, necessitates a comprehensive approach to address her specific needs.

Surgical Considerations
1. Surgical Technique: The primary goal of a hip replacement in cases like your girlfriend's is to restore function and alleviate pain. The surgeon will need to assess the condition of the surrounding soft tissues, the integrity of the hip joint, and the alignment of the femur and acetabulum. In some cases, soft tissue releases may be necessary to achieve proper alignment and function. However, the potential for nerve and vascular injury must be carefully managed.

2. Limb Length Discrepancy: Achieving equal limb length during hip replacement surgery can be challenging, especially when there is a pre-existing discrepancy of 5-6 cm. While some surgeons may attempt to lengthen the limb during the procedure, this is not always feasible or guaranteed. The surgeon's experience and the specific surgical approach will significantly influence the outcome. In some cases, additional procedures, such as limb lengthening surgeries, may be required postoperatively to achieve the desired length.

3. Postoperative Rehabilitation: After surgery, rehabilitation plays a crucial role in recovery. A tailored rehabilitation program that focuses on strengthening the hip muscles, improving range of motion, and enhancing balance is essential. Physical therapy should begin as soon as it is safe to do so, often within days of surgery, to prevent stiffness and promote healing.

Challenges and Solutions
1. Pain Management: Postoperative pain is a common concern. Effective pain management strategies, including medications and physical therapy, are vital to facilitate early mobilization and participation in rehabilitation.

2. Functional Recovery: Given your girlfriend's age and activity level, the goal of rehabilitation should be to restore her ability to walk without a limp and engage in daily activities. This may involve progressive weight-bearing exercises, gait training, and strengthening exercises for the hip and lower extremities.

3. Monitoring for Complications: Close monitoring for potential complications, such as infection, dislocation, or deep vein thrombosis, is essential. Regular follow-up appointments with the orthopedic surgeon will help ensure that any issues are addressed promptly.

4. Psychological Support: The emotional and psychological aspects of recovery should not be overlooked. Support from healthcare providers, family, and friends can help your girlfriend cope with the challenges of recovery and maintain motivation throughout her rehabilitation journey.

Conclusion
In summary, while the surgery to address your girlfriend's hip issues is complex, it is feasible in a well-equipped medical center in Taiwan. The potential for achieving equal limb length and restoring function will depend on the surgical technique employed, the surgeon's expertise, and the effectiveness of the postoperative rehabilitation program. It is crucial to have open discussions with the surgical team regarding expectations, potential outcomes, and the rehabilitation process to ensure that your girlfriend receives the best possible care. Seeking a second opinion or consultation with a specialized orthopedic surgeon experienced in complex hip replacements may also provide additional insights and options for her treatment.

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