Mal-united femoral fractures adjacent to loose total hip arthroplasties salvage with impaction grafting. A case report

Abstract

A 74 year-old man presented to our department with a loose femoral prosthesis, difficulty in walking and progressive shortening of his right lower limb. In 1973, during a road traffic accident, he suffered a basi-cervical fracture of the right neck of femur and a closed comminuted transverse fracture of the shaft of the ipsilateral femur, which was treated conservatively. One year later, the patient had a displacement intertrochanderic osteotomy and the following year, he underwent right cemented total hip arthroplasty (McKee-Arden). This prosthesis loosened with gross subsidence into varus (Fig. 1) and the patient had a revision to an uncemented prosthesis (Autophor) in 1991. On examination, the patient had a markedly short right leg by 8 cm. The radiographs confirmed subsidence of the femoral component, marked thinning of the cortex and mal-union at the site of the old fractured femur, such that the proximal and the distal femur were translated and overlapping (Fig. 2). The patient had revision with impaction grafting and some restoration of the leg length was achieved. The patient made excellent progress and 12 months following the revision, he had no pain and was walking with one stick. His radiographs showed no subsidence and no evidence of loosening. The bone graft appeared well-incorporated to the host femoral canal (Fig. 3).