Description of Event or Problem · 1
MALE PATIENT RECENTLY HAD 2 FAIRLY SEVERE FALLS ON THE ICE. HE HAS HAD A TOTAL HIP ARTHROPLASTY PROCEDURE PREVIOUSLY. HE PRESENTED RECENTLY WITH LARGE AREAS OF ECCHYMOSIS IN HIP AND INJURY TO SHOULDER. PATIENT WAS COUNSELED WITH REGARDS TO THE FACT THAT HE WAS TESTED FOR METAL ALLERGIES AND WAS TO HAVE A SKIN PATCH TEST WHICH WAS POSITIVE FOR METAL ALLERGY. HOWEVER, THE PATIENT DOES HAVE A METAL-ON-METAL TOTAL HIP ON THE CONTRALATERAL SIDE AND HAS NOT HAD ANY PROBLEMS WITH IT. IN ADDITION, THE PATIENT AHS BEEN COUNSELED WITH REGARDS TO THE FACT THAT THE CERAMIC HEAD DID FRACTURE AND PROS AND CONS OF A POTENTIAL METAL HYPERSENSITIVITY ALLERGY IF AN ADDITIONAL METAL-ON-METAL BEARING WOULD BE IMPLANTED. WE COMPARED AND CONTRASTED REPLACING THE FAILED IMPLANT WITH ANOTHER CERAMIC HEAD AND HAVING THE RISK OF ANOTHER FRACTURE. THE PROPORTIONAL RISKS AND COMPARISONS OF THESE 2 POTENTIAL COMPLICATIONS WERE DISCUSSED, REVIEWED. PT CONCURRED TO GO AHEAD WITH A METALLIC HEAD WITH THIS SURGERY. OPERATIVE NOTES: FASCIA OPENED IN LINE WITH FIBERS, PT FOUND TO HAVE TITANIUM STAINING IN THIS LAYER; DEBRIDED BOTH SHARPLY AND BLUNTLY TO REMOVE THIS. PT'S POSTERIOR CAPSULAR STRUCTURES HAD HEALED INTO A VERY THICKENED AREA OF SCAR WHICH WAS TAKEN DIRECTLY OFF THE SHARPEY FIBER ATTACHMENT ON THE GREATER TROCHANTER AND ELEVATED AS ONE LAYER. UPON ENTERING THE HIP, PT DID HAVE COPIOUS AMOUNTS OF FLUID IN THE HIP; WHICH WAS ALL CLEAR, BUT IT WAS BLACK STAINED AND MULTIPLE SMALL FRAGMENTS OF CERAMIC WERE ENCOUNTERED. HIP WAS DISLOCATED AND THE CERAMIC HEAD WAS FOUND TO BE MUCH MORE SEVERLY FRACTURED THAN THE CAT SCAN HAD SHOWN. IT WAS ACTUALLY BROKEN COMPLETELY IN HALF AND THEN ONE OF THE HALVES WAS BROKEN INTO MULTIPLE SMALL PIECES AS WELL. THIS WAS VISUALIZED AND THE CERAMIC WAS REMOVED. THIS WAS THEN FOLLOWED BY FINDING THE TRIGGER OF THE LOCKING MECHANISM FOR THE POLYETHEYLENE AND THEN REMOVING IT, WHICH WAS FOUND TO HAVE MULTIPLE AREAS OF ABRASIONS WITH SOME CERAMIC ACTUALLY EMBEDDED WITHIN IT. THE MORIS TAPER WAS ALSO NOTED TO HAVE SOME AREAS OF ROUGHNESS FROM CERAMIC DEBRIS. SURGERY CONTINUED, WOUND WAS CLOSED, AND THE PT RECEIVED 1300 ML OF CRYSTALLOID. PT HAD NOT RECEIVED ANY TRANSFUSIONS OR COMPLICATIONS AND WENT TO RECOVERY ROOM IN SATISFACTORY STABLE CONDITION. ======================MANUFACTURER RESPONSE FOR BIOLOX DELTA MODULAR CERAMIC HEAD, ======================WE RECEIVED A LETTER FROM BIOMET REQUESTING A MEDWATH REPORT.