Expert advice

Read what expert surgeons recommend on specific cases.

Advising expert: Luigi Zagra, Milano, Italy

Expert advice Hip Which THR, and how can I manage the anterolateral subluxation of the femoral head?

55-year-old female with avascular necrosis of the right hip: CT scan shows advanced OA right hip, with anterolateral subluxation of the femoral head. An intra-articular loose body is seen in the infero-posterior aspect of the acetabular fossa. THR is planned for this patient. Would like to ask an opinion on implant selection. Should I use total uncemented THR for both acetabulum and femur or should I use hybrid? Any difficulty I might encounter in this kind of case?

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Advising expert: Sanjiv Marya, Delhi, India

Expert advice Hip How can I manage this periprosthetic fracture, located below a cemented stem with absence of the lateral wall?

Permit me to share the X-rays of a 71-year-old man that had a fallen about 2 weeks ago sustaining a periprosthetic fracture. He had a right hip and knee replacement in a country in Asia in 2014 and has been having occasional pains at both sites more on the knee before the fall. No clinical or laboratory evidence of infection. X-rays of right hip shows fracture below the stem, absence of lateral wall of most of proximal femur with cemented stem projecting through it. What will you advise as the way forward and management options, please?

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Advising expert: Mohamad Allami, Baghdad, Iraq

Expert advice Hip What is the ideal cup position in ankylosing spondylitis patients?

What is the ideal position for the acetabulum cup in cases of THA in ankylosing spondylitis patients?

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Advising expert: Sebastien Lustig, Lyon, France

Expert advice Hip Which critique points pre and post op do you see in this Austin Moore hemiarthroplasty revision of an 65-year-old male?

Please tell critique points pre and post op, age 65 years male.

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Advising expert: Sam Oussedik, London, UK

Expert advice Knee Which approach to a primary knee prosthesis for a patient with a varus of 28 degrees?

Which is the way to approach a patient that requires knee primary prosthesis with a varus of 28 degrees. What prosthesis do you use? Is a revision or a hinge necessary? What critical steps would you identify to be careful with the surgery? Thank you

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Advising expert: Bas Masri, Vancouver, Canada

Expert advice Hip Long femoral stem or Corail stem to bypass 16 cm to the last hole of a DHS?

60-year-old male patient was operated 10 years before with a(dynamic hip screw (DHS). Patient developed right hip arthritis with the implant in situ. What would be the treatment plan? Is there a need for a long femoral stem or a Corail stem that can work from the greater trochanter to the last screw of the DHS (length 16 cm)?

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Advising expert: Matt P Abdel, Rochester, USA

Expert advice Hip What would be the ideal choice in a 68 y/o pt with subcapital fracture neck while recovering from CVA with hemiparesis?

What would be an ideal choice in a 68 years pt sustaining subcapital fracture neck of left femur, pt recovering from CVA 2 years ago with left-sided hemiparesis?

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Advising expert: David F Dalury, Towson, USA

Expert advice Knee How to achieve full extension of the knee postop TKA?

How to achieve full extension of the knee postop TKA?

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Advising expert: Michael Huo, Dallas, USA

Expert advice Hip How can I treat a 51 y/o male with an 8 cm leg-length discrepancy and weak abductors?

My patient is male 52 years old with clinical limb length discrepancy 8 cm with weak but working abductors.

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Advising expert: Gijs van Hellemondt, Nijmegen, Netherlands

Expert advice Hip What options are there for THR cases with a non-united greater trochanter fracture causing abductor lurch?

What options are there for THR cases with a non-united greater trochanter fracture causing abductor lurch?

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Advising expert: Michael Huo, Dallas, USA

Expert advice Hip What are the advantages and disadvantages of dual mobility total hip arthroplasty?

What are the advantages and disadvantages of dual mobility total hip arthroplasty?

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Advising expert: Bas Masri, Vancouver, Canada

Expert advice Knee What shall I use for a knee replacement, all poly or metal back tibia?

About knee replacement, all poly is better or metal back tibial component?

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Advising expert: Bas Masri, Vancouver, Canada

Expert advice Hip What is the cause of a young patient's hip pain, and how can we treat him best?

This is a 28-year-old patient with pain in both the hip joints for the past 2 years and now the pain worsened for the past 6 months with only partial relief with pain medication. I have attached the x-ray of this patient. Kindly suggest me the plan of management. I need your valuable suggestion on whether hip arthroplasty is needed or not.

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Advising expert: Jean-Noël Argenson, Marseille, France

Expert advice Hip How do I deal with hip osteoarthritis that involves a history of Perthes disease?

This patient is a 40-year-old male. Patient with history of Perthes disease presented with left hip osteoarthritis and THR done in our department which is the first time we did THR in our hospital. Need your opinion please.

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Advising expert: Jean-Noël Argenson, Marseille, France

Expert advice Hip What is the best method of revision for a 51-year old woman with rheumatoid arthritis after a successful THR?

51-year old woman with bilateral hip arthritis secondary to rheumatoid arthritis. She had a successful THR on the left in early Feb 2016. However, the right THR done late Feb 2016 was complicated by iatrogenic acetabular fracture and small bowel perforation. Bowel repair and implant explantation were done and antibiotic spacer was inserted. There is pelvic discontinuity on the left side as a result of the iatrogenic fracture. What would be the best method of revision for her?

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Advising expert: Fares Haddad, London, UK

Expert advice Hip Can you tell me the best femoral stem types to use in THR for cases of DDH?

What are the best femoral stem types to use in THR for cases of DDH? I have few adult DDH cases with advanced hip OA ranging from CROWE 2 to 4 with a small diameter femoral canals (10-15 mm).

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Advising expert: Fares Haddad, London, UK

Expert advice Hip What would be the best treatment for a young patient with acetabular fracture with an incarcerated femoral head?

I have a 37- year old female patient with a 7-month history of a left acetabular fracture. Physical and radiological evaluation showed: a limping gait, leg length discrepancy of 2cm, a non-union transverse fracture of the acetabulum with an incarcerated head of femur. What would be the best treatment option for her?

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Advising expert: Hassan Lauay, Sulaimmanyah, Iraq

Expert advice Hip Can you provide a guide for orientation in the acetabulum and femoral stem for THA when using the posterior or anterolateral approach?

I always have problems with the orientation of the acetabulum and femoral stem in THA when using the posterior and anterolateral approach. Can you provide me with a good, simple guide?

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Advising expert: Jean-Noël Argenson, Marseille, France

Expert advice Hip Do we have a viable option with predictable outcomes to prevent partial or complete loss of femoral head nucleus in children?

This was a much awaited initiative. My appreciations to the AO community for organizing it. In Asia we still have to deal (unsuccessfully) with the partial or complete loss of femoral head nucleus in children secondary to trauma, tubercular or septic arthritis and Perthes' disease. The treatment methodologies currently employed result in unpredictable outcomes. Various osteotomies, arthrodiastasis and arthrodesis are not completely successful. I have some experience with arthrodiastasis and osteotomies in such "non-salvageable" hips. I am also a believer in stimulation of biological regeneration of osseous tissues, and if possible the osteochondral tissue for the "re-formation" of the "biologically regenerated hip joint". Do we have a viable option with predictable outcomes for such hip joints in the paediatric population?

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Advising expert: Jean-Noël Argenson, Marseille, France

Expert advice Knee What is your preferred method of referencing (anterior or posterior) and why?

What is your preferred method of referencing (anterior or posterior) and why?

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