Abstract: Background: Complex primary total hip replacement presents a challenging condition for both new arthroplasty surgeons and experienced ones. Similar to a revision scenario, there may be difficulties such as shortening, soft tissue contractures, and fragile bones. Furthermore, these patients are at a higher risk of postoperative hip dislocation.
Method: We present a case of a 57-year-old patient with a Pipkin fracture of the left femoral head and avascular necrosis (AVN) of the femoral head. This patient had a history of chronic alcoholism and smoking and had experienced a fall four years prior, resulting in gross shortening and complete loss of hip movements, except for flexion from 200 fixed flexion deformity (FFD) to 70. To achieve good outcomes, we used the latest evidence and opted for a Capitol C Monoblock dual mobility cemented cup (Evolutis...) and Exeter V40 cemented stem (Stryker...) for left hip reconstruction, successfully achieving perfect limb equalization.
Conclusion: Total hip replacement in patients with alcoholism and ASA grade > 3+ is always a challenging surgical problem. Orthopaedic surgeons may not be aware that ASA grade > 3+ patients are at a higher risk of dislocation following hip replacement. By following the latest evidence-based principles and choosing a dual mobility cup for this patient, who had more than two risk factors for postoperative dislocation, we achieved a very good patient outcome.
