Complex Revisions in Total Hip Arthroplasty Amidst COVID-19 Delays: A Case Report.

Introduction: Avascular necrosis (AVN) of the femoral head and its subsequent management through total hip arthroplasty (THA) remains a significant challenge in orthopedic surgery, especially in cases with long-term complications. This case report is crucial as it documents the unprecedented journey of a 69-year-old female patient who underwent multiple revision surgeries over three decades, culminating in a complex surgical intervention during the COVID-19 pandemic. To the best of our knowledge, only a handful of cases have been reported in the literature that explores the compounded effects of delayed surgical intervention due to a global pandemic on a patient with a history of multiple hip arthroplasty revisions.

Case report: The patient, a 69-year-old female, initially presented with AVN of the left femoral head in 1994, for which she underwent an isoelastic cemented total hip replacement. Over the years, she required two revision surgeries due to implant loosening. In 2021, she presented with a dislocated femoral head and loosening of the cemented acetabular cup. The COVID-19 pandemic delayed operative intervention, leading to worsening complications, including proximal migration of the dislocated components. In 2022, a complex surgical procedure was performed, involving acetabular defect reconstruction and femoral shortening osteotomy, with the implantation of a new prosthetic body and a bipolar head. The surgery successfully restored hip stability, allowing the patient to walk with reduced risk of further complications.

Conclusion: This case underscores the complexities of managing long-term complications in patients with a history of multiple revision hip arthroplasties, particularly when external factors like the COVID-19 pandemic delay necessary interventions. The successful outcome of the case highlights the importance of personalized treatment strategies and adaptive surgical approaches in addressing severe complications. This case provides valuable insights for orthopedic surgeons and may have broader implications for managing similar cases in the future, especially in scenarios where timely surgical intervention is compromised by external challenges.