Abstract
Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later. Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications. Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases.
Highlights
Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications
If hardware removal and THA are performed in the same surgical step, pressurization of the cement can be impaired, fractures can occur due to weak bone and stress concentration, and infections related to previous surgeries cannot be ruled out.[1,2,3,4,5]
Soon after the hardware removal, an iatrogenic subtrochanteric fracture occurred, which was successfully treated with a primary tapered long-stemmed THA without any additional osteosynthesis
Summary
Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure.[1,2,3,4,5] High rates of complications, predominantly periprosthetic fractures, abductor dysfunction, and medical complications, were reported in the largest case series. The patient was treated with a two-step approach (hardware removal preceding THA). Soon after the hardware removal, an iatrogenic subtrochanteric fracture occurred, which was successfully treated with a primary tapered long-stemmed THA without any additional osteosynthesis. The patient was scheduled for a twostep approach (hardware removal preceding THA). Castagnini et al the bone stock after hardware removal and reduce the risk of iatrogenic fractures during stem positioning. Due to possible additional risks related to the reduced bone stock (intraoperative fractures, stem subsidence), the conversion to a single-stage procedure, that is, immediate THA, was not performed. The patient was advised not to weight-bear until a proper bone stock restoration was achieved. While a toe touch weight-bearing was allowed, the patient started complaining of hip pain. Radiographic examination revealed the healing fracture and a well-positioned implant with no signs of stem subsidence (Figure 2)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
