Neelaksh ., Gajanan Pisulkar, Sanjay Deshpande, Harrshit Salhan, Bhagyesh Sapkale
Early aseptic loosening following Total Hip Arthroplasty (THA) is an uncommon complication that may indicate implant-related, technical or biomechanical factors when it occurs within a short interval after primary arthroplasty. Early diagnosis along with timely revision surgery are important aspects in preserving bone stock while improving functional outcomes. Early aseptic loosening following THA is known as an uncommon but very significant cause of postoperative hip pain and functional limitation. The present case reports a 56-year-old male having progressive right hip pain, difficulty in ambulation two years following uncemented THA which was performed for avascular necrosis of femoral head. Clinical evaluation of patient showed no signs of infection and inflammatory markers were normal. Radiographs demonstrated progressive periprosthetic radiolucent lines around the femoral stem, suggestive of aseptic loosening. A diagnosis of aseptic implant loosening was established after excluding infective as well as other causes. The patient underwent revision THA during which acetabular component was found stable while the femoral stem was well fixed distally thus necessitating an Extended Trochanteric Osteotomy (ETO) for safe removal. A long uncemented revision stem was implanted showing satisfactory stability and osteotomy was fixed with cerclage wiring. Postoperative recovery was uneventful with good functional outcome. This case highlights the importance of early recognition of aseptic loosening and demonstrates the role of ETO in facilitating safe femoral stem removal and successful revision arthroplasty.