Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Intraoperative Management of Atypical Distal Femoral Neck Cut During Total Hip Replacement Paul E. Gerges, OMSIII 1 , Ralph Rizk, DO 2 . 1. VCOM-Carolinas. 2. Ralph Rizk Orthopedics, Jacksonville, FL.

Introduction

Results

Discussion

Surgical Outcome: • Successful restoration of hip biomechanics using a high offset stem and cement fixation. • Greater trochanter stabilized with transosseous sutures. Postoperative Recovery: • 2 weeks: No dislocation, stable repair, satisfactory wound healing. • 3 months: Partial weight-bearing, improved strength and mobility. Radiographic Results: Imaging confirmed proper implant positioning and stability throughout recovery.

Introduction • Total hip arthroplasty (THA) is a widely performed procedure to: • Restore joint function. • Alleviate pain in patients with advanced arthritis or hip fractures. • Improve quality of life through prosthetic joint replacement. • Key factors for successful THA:

References • Key Challenges: • Atypical femoral neck cut and greater trochanter avulsion during surgery. • Solutions Applied: • High-offset femoral stem to restore lateralization and leg length. • High-viscosity cement fixation for immediate structural stability. • Transosseous sutures to repair abductor mechanism and prevent dislocation. • Role of Advanced Technology: MAKO robotic navigation ensured precise component placement and avoided impingement. Conclusions • Adaptability during surgery is critical for managing complex cases. • High-offset femoral stems and advanced fixation techniques ensure optimal outcomes. • Future research should focus on robotic navigation’s role in managing complex intraoperative challenges in arthroplasty. 1.Sariali, E., et al. (2009). High-offset stems in THR: Functional outcomes. 2.Weber, M., et al. (2018). Fixation strategies for greater trochanter fractures. 3.Callanan, M., et al. (2011). Robotic navigation for precise implant positioning. We extend our gratitude to Henry Walters, the Stryker representative, for providing technical support and valuable insights during the surgical procedure. We also thank Ascension St. Vincent's Riverside Hospital for their exceptional facilities and support in ensuring a successful surgical outcome. Special appreciation goes to Dr. Ralph Rizk for his invaluable guidance and mentorship throughout this case report, which greatly contributed to its completion. Acknowledgements

• Achieving proper leg length, femoral offset, and biomechanics. • Utilizing precise surgical techniques to ensure functional outcomes. • Challenges during THA: • Intraoperative complications such as: • Atypical femoral neck cuts. • Greater trochanter avulsion injuries. • These can compromise hip biomechanics and functional outcomes if not addressed. • Case highlights: • Management of an atypical distal femoral neck cut and greater trochanter avulsion during a right total hip replacement. • Surgical modifications included: • High-offset femoral stem. • Cement fixation. • Transosseous sutures for greater trochanter reattachment. • Role of advanced tools: • Use of CT-based imaging and robotic navigation for precise planning and surgical execution. • Enhanced precision ensured optimal component placement and biomechanical restoration. Preoperative Imaging: X-rays and CT scans with MAKO robotic navigation for precision. Surgical Plan: • Anterior approach THR with Trident® II acetabular cup and Accolade® C femoral stem. • Planned for potential bone quality and soft tissue balance challenges. Intraoperative Challenges and Solutions: • Atypical femoral neck cut and greater trochanter avulsion. Solutions applied: • High-offset femoral stem for biomechanical restoration. • Cemented fixation for structural support. • Transosseous sutures for greater trochanter reattachment. Methods

Figure 1. AP View . Intra-op view Avulsion of Greater Trochanter

Figure 2. AP View. Post-op Transosseous sutures applied and cement fixation for the implant

2025 Research Recognition Day

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