Musculoskeletal
Nicholas Cusmano, MD
Medical Student (MS4)
Central Michigan University College of Medicine
Grosse Pointe Shores, Michigan, United States
Margaret Snow, MD
Attending Physician
Free Bed Mary Covenant
Saginaw, Michigan, United States
Nicholas Cusmano, MD
Central Michigan University College of Medicine
Grosse Pointe Shores, Michigan, United States
With 2.5 million Americans living with a total hip replacement in 2010, complications of aging prosthetics are presenting in novel ways. This case presents a displaced, periprosthetic fracture of the femoral shaft that led to the surgical replacement of the proximal femur.
An 89-year-old female with prior history of left total hip arthroplasty presented to the Emergency Department with severe left hip and thigh pain. One year prior, the patient sustained a fall from standing height, in which radiographs revealed significant loosening of her prosthesis and severe thinning of the lateral cortex. Surgical revision was declined at the time. The patient noted worsening pain and instability in the days prior to arrival, which progressed until she collapsed when her leg gave way. In the ED, physical exam demonstrated deformity and tenderness to palpation over the left thigh with no open wounds or tenting. Subsequent radiographic imaging revealed a Vancouver B3 periprosthetic fracture of the left femur. She underwent proximal femoral replacement the following day and was transferred to a rehab unit 2 days later. After a 23-day rehab stay, she was discharged in stable condition.
Regardless of etiology, proximal femoral replacement remains a rare intervention without rehab guidelines beyond posterior hip precautions. This example showcases a traumatic cause and considers functional limits after the loss of all muscle attachments about the greater & lesser trochanters, as well as the gluteal tuberosity. Notably, perpetual decreased motor power from hip abductors, extensors, and external rotators requires permanent use of a walker during weightbearing activity. We hope to add to the limited research by providing a case to guide future clinical decision making.
Beyond the broader application of posterior hip precautions, this case illustrates a traumatic complication of hip prosthetics and the specialized rehab management for patients following a proximal femur replacement.
