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* 1. Please indicate intraoperative findings for the failure mode: Dislocation/Instability (Choose ALL that apply)

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* 2. Was there a Liner Failure?

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* 3. What is the direction of dislocation?

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* 4. Is there damage from impingement to the components?

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* 5. What type of impingement did you notice? (Check all that apply)

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* 6. Prior to your revision, was the hip you are revising stable to your routine intra-operative exam, i.e. would you have left the OR feeling comfortable with the intra-op stability testing (do not judge based on component position, only stability testing)?

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* 7. What is the quality of the abductor muscles

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* 8. What is the quality of the posterior soft tissue sleeve?

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* 9. What did you do to address the instability? (Check all that apply)

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* 10. If you increased offset and/or leg length, did you exceed normal to achieve stability?

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* 11. Please indicate the PREVIOUSLY IMPLANTED Device Fixation for ACETABULUM

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* 12. Please indicate the PREVIOUSLY IMPLANTED Device Fixation for FEMUR

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* 13. Please indicate Special Techniques performed on the femur (choose all that apply)

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* 14. Please indicate the Femoral Implant Types (Choose ALL that apply)

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Femoral Bone Loss Classification (Paproksy Class)

Femoral Bone Loss Classification (Paproksy Class)

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* 15. What was the FEMORAL BONE LOSS CLASSIFICATION (Paprosky Class)?

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Acetabular Bone Loss Classification (Paprosky Class)

Acetabular Bone Loss Classification (Paprosky Class)

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* 16. What was the ACETABULAR BONE LOSS CLASSIFICATION (Paprosky Class)?

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* 17. Indicate any Intra-Op Complications

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* 18. Was a deep drain used?

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