A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed 22 years earlier: a case report

Journal of Medical Case Reports

Atsuhiko Mogami¹  Osamu Obayashi¹  Kazuo Kaneko²  Akio Kanda¹ 

[1]Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Izunagaoka 1129, Izunokuni-country 410-2295, Shizuoka, Japan

[2]Department of Orthopedic Surgery, Juntendo University, Hongou 3-1-3, Bunkyou Ward 113-8431, Tokyo, Japan

关键词: Infection;    Hemiarthroplasty;    Femoral neck fracture;    Femoral head migration;    Acetabular articular cartilage;   

Others  :  1180813
DOI  :  10.1186/1752-1947-9-17

 received in 2014-08-24, accepted in 2014-12-08,  发布年份 2015

【 摘 要 】

Introduction

Treatment of femoral neck fractures in young adults may require total hip arthroplasty or hip hemiarthroplasty using a bipolar cup. The latter can, however, result in migration of the femoral head and poor long-term results.

Case presentation

We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof. After bone union of the femoral shaft fracture, the patient was referred to our hospital for reconstruction of the acetabular roof. Intra-operatively, we placed two alloimplants of bone from around the transplanted femoral head into the weight-bearing region of the acetabular roof using an impaction bone graft method. We then implanted an acetabular roof reinforcement plate and a cemented polyethylene cup in the position of the original acetabular cup. Eighteen months post-operatively, X-rays showed union of the transplanted bone.

Conclusions

Treatment of femoral neck fractures in young adults is usually accomplished by osteosynthesis, but it may be complicated by femoral head avascular necrosis or by infection or osteomyelitis. In such cases, once an infection has subsided, either hip hemiarthroplasty using a bipolar cup or total hip arthroplasty may be required. However, if the acetabular side articular cartilage is damaged, a bipolar cup should not be used. Total hip arthroplasty should be performed to prevent migration of the implant.

【 授权许可】

   
2015 Kanda et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

【 参考文献 】

• [1]Narayan KK, George T. Functional outcome of fracture neck of femur treated with total hip replacement versus bipolar arthroplasty in a South Asian population. Arch Orthop Trauma Surg. 2006; 126:545-548.
• [2]van Egmond PW, Taminiau AH, van der Heide HJ. Hemiarthroplasties in young patients with osteonecrosis or a tumour of the proximal femur: an observational cohort study. BMC Musculoskelet Disord. 2013; 14:31. BioMed Central Full Text
• [3]Nakata K, Ohzono K, Masuhara K, Matsui M, Hiroshima K, Ochi T. Acetabular osteolysis and migration in bipolar arthroplasty of the hip: five- to 13-year follow-up study. J Bone Joint Surg Br. 1997; 79:258-264.
• [4]Tsumura H, Torisu T, Kaku N, Higashi T. Five- to fifteen-year clinical results and the radiographic evaluation of acetabular changes after bipolar hip arthroplasty for femoral head osteonecrosis. J Arthroplasty. 2005; 20(7):892-897.
• [5]Rodríguez-Merchán EC. Displaced intracapsular hip fractures: hemiarthroplasty or total arthroplasty? Clin Orthop Relat Res. 2002; 399:72-77.