58-year follow-up of a vitallium mold hip arthroplasty: A case report and literature review

In 1948, a 10-year-old boy presented to the Royal Children’s Hospital in Melbourne with painful right hip. Radiographic examination at that time revealed a slipped upper femoral epiphysis. This was treated with manipulation under general anaesthetic and plaster immobilization. At follow up after 6 months, it was noted that his right leg was shorter than his left and radiographs showed avascular necrosis in the right femoral head. He then underwent a Smith-Petersen vitallium mold hip arthroplasty at the age of 11.

He was referred to our clinic recently, now 70 years of age, complaining of weakness of the right leg that had been coming on gradually for the previous 10 years. Because of this problem, his exercise tolerance had deteriorated over the previous 18 months. He had taken to using crutches and a wheelchair to remain mobile. He denied any feelings of pain or discomfort around the hip, or numbness in the leg.

He walked with a limp, and the Trendelenberg test was positive due to abductor weakness. Movements of the hip were: flexion 60º, abduction and adduction 30º each, internal rotation 0º, and external rotation 30º. He had no fixed flexion deformity of the hip. The right leg was 10 cm shorter than the left, and the patient felt that this leg length discrepancy had progressed recently. The weakness and positive Trendelenberg test was thought to be due to shortening of the lever arm because of progressive erosion of the femoral neck (Figure). He scored 18 on the Oxford hip score and 70 on the Harris hip score. The patient was not keen to consider revision surgery.