Post-traumatic End-Stage Hip Osteoarthritis Decades After an Adolescent Gunshot Wound Treated With Direct Anterior Total Hip Arthroplasty: A Case Report.

Gunshot wounds to the pelvis during adolescence are uncommon but may result in long-term orthopedic complications, including pelvic asymmetry, acetabular deformity, and early development of hip osteoarthritis, which can complicate later reconstructive surgery. We describe the case of a 53-year-old woman who sustained a through-and-through gunshot injury to the left pelvis at age 16 and presented decades later with progressive left hip pain, functional limitation, and worsening leg length discrepancy. Imaging demonstrated severe post-traumatic end-stage osteoarthritis of the hip, acetabular deformity, pelvic obliquity, heterotopic ossification, and retained metallic fragments. After failure of nonoperative management, she underwent direct anterior total hip arthroplasty (THA) with preoperative CT-based planning and a strategy of partial limb-length correction to reduce neurologic risk. Postoperative radiographs confirmed appropriate implant positioning without evidence of loosening or subsidence. At two weeks postoperatively, the patient reported meaningful pain relief, improved mobility with a cane, and an uncomplicated wound healing course. This case illustrates that direct anterior THA can be successfully performed in the setting of complex post-traumatic deformity when meticulous preoperative planning and cautious intraoperative technique are employed.