Aseptic Loosening of Bipolar Hemiarthroplasty in a Young Adult Managed by Conversion to Dual Mobility Total Hip Arthroplasty Complicated by Early Dislocation and Subsequent Infection.
Amit Kale, Pankaj Sharma, Sudheer Goli et al.
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Case in brief
A 35-year-old man with prior tuberculous meningitis and bilateral avascular necrosis developed persistent pain and restricted movement after right bipolar hemiarthroplasty. Conversion to total hip replacement was followed by early recurrent instability, prompting revision with a long uncemented stem, cerclage fixation of an intraoperative proximal femoral fracture, and a dual mobility construct. Intraoperative culture during the revision/infection course grew Klebsiella pneumoniae. He received six weeks of intravenous ceftazidime-avibactam and aztreonam, with serial inflammatory markers monitored after debridement and targeted antibiotics.
What made this case unusual
The conversion and revision course combined early recurrent dislocation, an intraoperative proximal femoral fracture, and culture-positive Klebsiella pneumoniae infection in a young adult.
Diagnostic / clinical pearl
Persistent pain and restricted movement after bipolar hemiarthroplasty may lead to technically complex conversion; recurrent instability and positive intraoperative cultures can further shape revision reconstruction and infection management.