Simultaneous primary bilateral hip resection arthroplasty

Abstract

Hip resection arthroplasty is a useful procedure for the management of complex hip problems and in patients with high surgical and anesthetic risk factors. Unilateral procedures performed for failed total hip arthroplasty have been shown to be successful for pain relief with acceptable functional outcomes; however, to our knowledge, no research exists on simultaneous bilateral hip resection arthroplasty for femoral head osteonecrosis. We present two cases of single-stage bilateral hip resection arthroplasty performed under singular anesthetic procedures for femoral head osteonecrosis. The patients were each able to stand for transfers postoperatively and had no deterioration in pain or function. These two cases demonstrate that satisfactory pain control with preservation of function may be achievable with bilateral hip resection arthroplasty procedures in patients who are not a candidate for more advanced reconstructive procedures.

Keywords: Bilateral hip resection arthroplasty; Femoral head osteonecrosis; Girdlestone procedure; Hip avascular necrosis.

Figure 1

Preoperative radiograph of the AP pelvis demonstrates bilateral femoral head deformity with flattening and subchondral sclerosis. There are severe degenerative changes including narrowed joint space and acetabular sclerosis and subchondral cysts.

Figure 2

Preoperative T2 coronal (a), T1 coronal (b), and T1 axial (c) MRI scans demonstrating signal changes at the weight-bearing portions of the femoral heads consistent with necrotic tissues. T2 MRI showed high signal intensity consistent with edema around the area of necrotic tissues.

Figure 3

Intraoperative fluoro of bilateral hips before (a, c) and after (b, d) femoral neck cuts. The “a” and “c” also show the location and orientation of the osteotome to be low on the neck and parallel to the intertrochanteric line.

Figure 4

Intraoperative clinical photos of right (a) and left (b) femoral heads and necks showing delamination of the cartilage with exposed, collapsed subchondral bone.

Figure 5

Postoperative, non-weight-bearing AP pelvis radiograph showing superior migration of bilateral femurs without direct contact to the acetabula.

Figure 6

AP pelvis of case 2 demonstrating destructive, end-stage, bilateral femoral avascular necrosis with complete collapse, destructive erosive changes of the dome of both acetabulum with significant superior and lateral migration of the femoral heads. Antibiotic beads are present in the right hip along with a short cephalomedullary nail in the left hip.

Figure 7

Postoperative non-weight-bearing AP pelvis of case 2 after bilateral Girdlestone procedure, demonstrating superior femoral migration without direct bony contact to the acetabulum.