Dr. Lurate performed the cases described below with impressive results. From a surgeon's perspective they represent incredibly complex and difficult cases. These cases have been shown in educational conferences to demonstrate these advanced techniques.

Case One
This 53-year-old gentleman presented with a fracture of his right femur. He had a complicated history related to a broken hip in the late '60's. After several surgical procedures on his hip, he had resigned himself to a rather sedentary lifestyle with chronic hip pain along with a rather dramatic limp resulting form his pain, muscle weakness, and substantial shortening of his right leg. Both the stem and cup of his previous hip replacement had loosened. His previous surgery and subsequent severe loosening of his total hip replacement (THR) had resulted in severe bone loss and weakening of the remaining bone. Thus with minor trauma, he had fractured through the femur. Most specialists would agree that this represents one of the most difficult revision operations we face in hip surgery.


In this case, several special techniques were utilized. The large defect in the acetabulum of the pelvis (socket or cup) was reconstructed with bulk allograft. Allograft is human bone from a bone bank. The femur not only had several large defects but also had areas of "egg shell" thinning. The femur was reconstructed with a combination of bulk allograft and morselized allograft utilizing a revolutionary technique called impaction grafting. The result was extraordinary. He demonstrated dramatic improvement in his pain, walking ability, and leg length.

Case Two
This is the case of a 52-year-old woman with developmental dislocation of the left hip. This uncommon condition presents with varying degrees of severity. Fortunately, most cases can be successfully managed as an infant. However, in its most severe form, it can result in total and permanent dislocation of the femoral head (ball) out of the acetabulum (socket). This is such a case. At presentation she had severe pain on a daily basis with over 6 centimeters of shortening of the left leg compared to the right. As you might expect, this resulted in a rather impressive alteration in gait. In the past, she had been advised against an operation by previous orthopaedic surgeons due to the complexity and associated risk.

She was managed with a technique that restores more normal biomechanincs to the hip. This was done by relocating the hip to a more normal center of rotation (the area of the true acetabulum) while reconstructing the femur to protect the sciatic and femoral nerves. She achieved a sensational result with marked improvement in her gait (due to improved muscle function and improvement of her leg length inequality) as well as resolution of her intense pain. She was very grateful for her referring physician.

Case Three
This is the case of a woman with chronic thigh pain despite having had a hip replacement. She had previously had her hip replaced with a hip that the "bone was supposed to grow into." Hip replacements such as that are sometimes referred to as "press-fit" or "ingrowth" prosthesis in which no bone cement is used. While an ingrowth prosthesis can be quite successful, it can also be a source of persistent hip pain if bony stability is not achieved. Unfortunately, such stability did not occur in her case and she came to accept the chronic pain. Circumstances changed when she tripped and fell hard onto her hip resulting in the devastating fracture seen below. Seeing evidence of previous loosening of her prosthesis and learning of her preoperative thigh pain, Dr. Lurate not only reconstructed her femur fracture, but also replaced the loose hip component with a new one. After a typical recovery time, she eventually healed her fracture and saw her thigh pain disappear.

Dr. Lurate’s commitment to minimally invasive surgery (MIS) has led to his refinement of his approach to total hip replacement over the past 10 years. He utilizes 2 techniques which depend on patient driven factors. One technique involves a single incision usually about 3 inches in length. The other involves a 2 incision technique whereby one incsion is typically 2.5-3 inches and the other is usually 1.5 inches. Both techniques have their advantages. Either way, there is a drastic reduction in the amount of tissue and muscle dissection that occurs with the standard surgical techniques which tyhpically utilize a 8-12 inch incision. For the patients that are looking for the fastest recovery possible, the MIS hip replacement is a very attractive option. Below are pictures and xrays of typical patients of Dr. Lurate’s who have had the MIS hip replacement.