Revision total hip arthroplasty using ETO for failed bipolar hemiarthroplasty with protrusio acetabuli

A woman in her 40s presented with persistent left hip pain and restricted motion for 5 years. X-ray findings revealed an uncemented bipolar stem, tension band wiring of greater trochanter with K wires, a broken Shenton line and protrusion acetabuli. The patient previously underwent unsuccessful cancellous screws fixation for an intracapsular neck of femur fracture, leading to non-union and subsequent bipolar hemiarthroplasty outside our facility. The planned extended trochanteric osteotomy (ETO) aimed to remove the stem, assess the acetabular defect and fill it with allograft. The use of a distal fitting stem would bypass the need for ETO. This case underscores the significance of meticulous preoperative planning and well-equipped instruments. Performing an ETO may be necessary for achieving hip dislocation in these procedures, and using allograft may be an effective approach to managing acetabular defects, with reduced morbidity to the patient.