Abstract
Fibroblast growth factor 23 (FGF23) was recently identified as an important factor involved in the development of hypophosphatemic rickets and osteomalacia. We experienced a rare case of acute prosthesis migration after hemihip arthroplasty due to FGF23-induced tumor. The patient underwent femoral head replacement because of femoral neck fracture, but prosthesis migration was occurred at 1 week after operation. The patient took various examinations, and FGF23-induced tumor was found in his right wrist. The tumor was resected, and he underwent total hip arthroplasty 8 month later. Finally, he was able to obtain free gait without pain.
Highlights
Fibroblast growth factor 23 (FGF23) was recently identified as an important factor involved in the development of hypophosphatemic rickets and osteomalacia [1, 2]
We presented a case of acute prosthesis migration after hemihip arthroplasty due to osteomalacia by FGF23-induced tumor
Gadolinium enhanced MRI image showed non homogeneous high intensity lesion was detected along radius, and Osteomalacia is a generalized mineralization disorder of the osteoid matrix, consisting of a deficit in calcium and phosphate incorporation [4, 5]
Summary
FGF23 was recently identified as an important factor involved in the development of hypophosphatemic rickets and osteomalacia [1, 2]. A 66-year-old man was fallen down from ladder and was unable to stand up He was taken emergency transportation to high care unit. X-ray finding revealed the left femoral neck fracture, and the bone density of proximal femur was normal (Figure 1(a)). Intraoperative findings showed that the quality of bone was not so fragile during cutting femoral neck and stem insertion. The surgeons used cemented stem with thirdgeneration cementing technic, but did not try press fit during component trial and stem insertion They did not verify the actual bone quality. That stability of stem was good after implantation (Figure 1(b)) They did not consider that the fracture was caused by osteomalacia due to tumor. The X-ray at one week later after operation showed the alignment of stem had been varus (Figure 1(c)).
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