Non-standard clinical case: a 13-year journey from primary hip replacement to a custom 3D implant

Relevance: The uniqueness of the clinical case lies in the prolonged dynamic 13-year observation of a patient with THA who, after endoprosthetics, underwent a whole range of surgical interventions and complications. She suffered various types of osteosynthesis, fractures of installed implants and their dislocations, periprosthetic infection, and installation of a spacer. As a result of numerous operations, the patient developed a pronounced defi cy of bone tissue in the lower third of the operated hip with a signifi ant bone defect. As a possible effective option for its replenishment, a 3D personalized revision endoprosthesis leg with a partial bone mantle was used.Case description: A 64-year-old female patient, 2 years after THA of the right hip joint, with good clinical and radiological results, received a Vancouver type “C” periprosthetic fracture followed by osteosynthesis of the femoral fracture with a plate and Cable Ready cables. The fall subsequently resulted in a fracture of the right femur and the fixation plate, with a stable cup of the installed endoprosthesis. Osteosynthesis was performed with an NCB plate, the stem was replaced with a Wagner Rev.SL, and the tribological pair was replaced. After 2 years, removal of the unstable NCB plate due to a healed hip fracture. After 3 years, there was septic loosening of the endoprosthesis leg with its removal and installation of a 3D spacer, its dislocation on the day of suture removal due to non-compliance with the motor regime. After the infection was relieved, a 3D personalized leg was made for the patient. During preoperative preparation, the patient experiences a fracture of the spacer. Final surgical treatment: in one surgical session, a broken spacer was removed, an anti-protrusion ring with a cup of the Avantage dual mobility system, a personalized 3D implant of the endoprosthesis leg, an NCB plate, and Cable Ready cables were installed. In the lower sections, the leg is fixed in the femoral canal with cement. In the upper parts of the leg there is osseointegration with the bone. This technique made it possible to reinforce the femur intramedullary, compensate for the existing bone deficiency in the lower third of the femur, restore the range of motion in the joint, minimizing the risks of dislocations with double mobility, and provide support to the limb. The total follow-up period for the patient was more than 13 years.Conclusion: The presented clinical case illustrates one of the methods of a possible personalized approach to replenishing the existing defi cy of bone tissue of the lower third of the femur, which arose as a result of multiple surgical interventions on the hip joint associated with coxarthrosis and endoprosthetics.