Abstract
This case report describes two cases of peri-prosthetic fracture during physical therapy in patients who underwent a hip resurfacing, or surface replacement arthroplasty. The fractures occurred with forceful passive combined flexion and external rotation. Functional results were ultimately obtained in both cases, requiring conversion to total hip arthroplasty. Recognizing patient risk factors and cautioning therapists about the possibility of fracture may have prevented these complications.
Highlights
Hip surface replacement arthroplasty (SRA) is an increasingly popular option for treating degenerative hip disease, in the young and active patient [1]
Femoral neck fracture may increase as a function of elevated body mass index (BMI)
Radiographs at that time showed no significant change in hip SRA placement, but mild lower extremity shortening due to initial positional change of the femoral component
Summary
Hip surface replacement arthroplasty (SRA) is an increasingly popular option for treating degenerative hip disease, in the young and active patient [1]. Radiographs at that time showed satisfactory placement with no evidence of fracture, migration, or loosening (Figure 1) She was allowed to discontinue her posterior hip precautions and referred to an outpatient physical therapist for continued outpatient strengthening and range of motion rehabilitation. Radiographs from the 6-week post-op visit showed satisfactory alignment and no evidence of fracture, loosening, or subsidence (Figure 4) At this time her posterior hip precautions were discontinued, and she began outpatient rehabilitation with a therapist in her community. Radiographs at that time showed no significant change in hip SRA placement, but mild lower extremity shortening due to initial positional change of the femoral component Her weight bearing status was advanced to fifty percent from 6 to 12 weeks following fracture, full weight bearing 12 weeks post-fracture. The patient chose to undergo revision to THA at an outside facility in an identical fashion to Case #1 and is pain free
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