• 57 years old gentleman
• Medical history: high blood pressure, right THR post-traumatic in 1993
• Right hip pain increasing for more than 10 years but patient was scared to see a specialist.
• Walk with 1 cane
• Lower Limb Discrepancy of 3cm
• Lateral and anterior incision on the hip not inflammatory
• Range Of Motion : 90 / 0 / 30 / 30 / 20 / 0
• Palpation of a soft mass in the groin
• Blood sample: normal hemogramm and CRP <5

What additional imaging or test do you ask?

• ✔️MRI
• ✔️Bone Gammagraphy

What are your diagnostic hypotheses?

• ✔️Metal allergy

Infection and cancer work-up were negative

A hip revision with a stemmed cup (transtrochanteric approach for gluts) and Allograft Prosthetic Composites was performed

A Lagrange and Letournel femoral cemented stem was implanted

Continuation of the patient's medical journey

At Post-Op day1, patient had increased pain, a sensation of instability and a sciatic nerve palsy (new)

A removal of the cup (in the sciatic nerve) was done

2 months after (without weight bearing and denutrition) a complex cup revision was performed

But... We noticed after removal of the drapes a massive knee instability that was not known before, and we asked for an x-ray.

Internal fixation was impossible because there wasn’t enough bone distally. A Hinge TKR and a  bridging plate were fitted.

But it’s not finished…

• At Post-Op Day 12, hip and knee wounds were purulent, T°C was at 39°C and CRP at 300
• Patient underwent DAIR of hip + femur + knee
• At Post-Op Day 17 of the second surgery, CRP increased again at 250 (after having decreased), both wounds were inflammatory, T°C was 38°C (patient was under effective bi-antibiotherapy)
• A 2nd DAIR procedure was performed
• 2 weeks after, same septic failure happened and patient dislocated (several times)

 A 2 stage surgery was planed: 1st stage of ilio-tibial spacer then total femur.

• During 1st stage, Blood loss were massive (15 red cells unit) and the patient was hemodynamicaly very unstable +++
• We Decided to close for hemostasis purpose before implantation of the spacer and decided a hip disarticulation after patient stabilised…

A Hip disarticulation was done one week later