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Medical Marvel #10

Hip-replacement complications may cost a woman her leg.

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Patricia Bennett and Geoffrey Westrich.  

Patient: Patricia Bennett
Doctor: Geoffrey Westrich, orthopedic surgeon, Hospital for Special Surgery

Patricia Bennett: I’m 66, and my husband isn’t well: He’s had strokes, he’s diabetic, and he’s on dialysis. I drive and I clean and I do the laundry and the shopping and—just about everything.

Westrich: I first saw Mrs. Bennett on January 12, 2005. She had a terrible deformity of the left leg; it was markedly shortened and swollen. She was at risk of losing it.

Bennett: I had a hip replacement about fifteen years ago because of rheumatoid arthritis. Over the years the prosthesis became loose, so I ended up, in 2002, going to a surgeon in Connecticut. But when he did the surgery, he fractured my femur. That’s where my horror started.

Westrich: I’m not sure they noticed the fracture when it occurred. She thinks maybe there was an attempt to fix it during the surgery. Whatever they did, it didn’t work well.

Bennett: Three months later, the doctor told me that the pins he had put in were coming out. I had new equipment put in, but the swelling wasn’t going down. The doctor said it was probably infected. I was on crutches, and I couldn’t do anything. I saw at least five surgeons, and each time, they would say, “I’ve never seen a leg like this.” One of them said to me, “Well, I think we’ll just cut that leg off.” I thought, I can’t do this! I have to take care of my household. Eventually, I was referred to Dr. Westrich.

Westrich: You put up the X-rays and your jaw drops. They took out as much of the hardware as they could at the fracture site, but they left the stem of the hip replacement. She had a hip replacement up top, a long stem, but the lower half of her femur was gone. She had some fragments, a lot of debris, broken screws—it was a disaster. They told her there was no way for her to heal because she was missing all this bone. I said to her outright, “The last thing we want to do is take off your leg.”

Bennett: I was so thrilled, I broke down in tears. Somebody positive!

Westrich: With chronically infected joint replacements, you can try just antibiotics, but the success rate is terrible. So you need a two-stage operation. Operation No. 1 is taking out all the foreign material and then putting in an antibiotic-impregnated temporary femur, as a “spacer.” But we had nothing available to create the spacer. So I went to a company that makes femur replacements and had them donate the longest trial femur they had, and I basically made her an artificial femur, which would provide not only stabilization but a very high dose of antibiotics.

Bennett: He had this prosthesis custom made. He said it was like a jigsaw puzzle.

Westrich: Then she got six weeks of intravenous antibiotics, and then we went back in, took everything out, and put in a total femur replacement. The permanent replacement is made of titanium, cobalt-chromium, and high-density plastic where the joints are. It’s an unbelievable piece of equipment—a total hip replacement at the top, a total knee replacement at the bottom, and a long tube that connects the two. The final surgery was on June 9.

Bennett: My birthday’s June 10. I said to him, “The best birthday present you can give me is to tell me my leg’s gonna be okay.”

Westrich: It almost brings tears to your eyes when you listen to her talk about her recovery. She was so debilitated for so many years, and now you watch her walk, and it’s night and day.

Bennett: I’m almost back to myself again. I do everything in the house. I came home and I painted all the cabinets in my kitchen. I’m planning an 18th birthday for my granddaughter. I tell everybody I’m in love with my surgeon.


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