1329 - Hip Fracture in a Patient with VEXAS Syndrome: Rehabilitation Following Hemiarthroplasty

The patient sustained a Garden type III right femoral neck fracture after a ground-level fall and underwent uncomplicated hemiarthroplasty. Standard anticoagulation was contraindicated due to chronic thrombocytopenia, so postoperative venous thromboembolism prophylaxis was limited to compression devices and TED hose.

VEXAS syndrome is a recently defined disorder caused by somatic mutations in the UBA1 gene within hematopoietic progenitors, leading to defective ubiquitylation, innate immune activation, and systemic inflammation. It primarily affects older men and presents with fevers, chondritis, vasculitis, pulmonary infiltrates, and hematologic abnormalities including macrocytic anemia and severe cytopenias. Many patients become transfusion-dependent, increasing perioperative and rehabilitative risks.

During rehabilitation, this patient developed recurrent anemia and thrombocytopenia requiring transfusions of red blood cells and platelets to maintain stability and continue therapy. With this support and close interdisciplinary monitoring he progressed from maximal to minimal-moderate assistance for bed mobility, transfers, and short-distance ambulation.

Discussions: This is the first reported case, to our knowledge, of a patient with VEXAS syndrome undergoing hip fracture repair followed by inpatient rehabilitation. Despite recurrent cytopenias requiring multiple transfusions, coordinated interdisciplinary care allowed rehabilitation to proceed.

Conclusions: This case highlights the feasibility of intensive rehabilitation in patients with VEXAS syndrome after orthopedic surgery. We found that close monitoring, facilitation of transfusions, and close collaboration between medical and rehabilitation teams are critical to optimizing functional recovery in patients with this rare and complex condition.