1424 - Complex Regional Pain Syndrome (CRPS) Type I After Proximal Femur Fracture Treated With Total Hip Replacement: A Rare Case Report

Case Diagnosis: Complex Regional Pain Syndrome (CRPS) type I following a proximal femur fracture treated with total hip replacement (THR).

Case Description: Persistent pain after THR is uncommon and warrants careful evaluation to exclude
mechanical or infectious causes. A 56-year-old male sustained a proximal femur
fracture managed surgically with THR. About six weeks postoperatively, he
developed severe, disproportionate pain in the operated hip and leg. The pain
intensified and was accompanied by hypersensitivity, including allodynia and
hyperesthesia. Comprehensive workup with imaging, laboratory studies, and hip
aspiration ruled out infection, prosthesis loosening, and other complications. After
nearly one year of persistent symptoms, a clinical diagnosis of CRPS type I was
established. Management with titrated doses of tramadol and gabapentin, structured
physical therapy, and adjunctive medical cannabis reduced his pain from 7/10 to
3–4/10 and improved mobility and independence.

Discussions: CRPS is typically reported after distal extremity trauma, especially involving the
wrist or ankle, and has been rarely described in the hip region. Additionally, CRPS is
more frequently reported in women, making this presentation in a middle-aged male
even more unusual. This case emphasizes that CRPS should also be considered in
patients with persistent, disproportionate pain following proximal femur fractures
treated with THR, once standard postoperative complications have been excluded.

Conclusions: Although rare in proximal joints, CRPS may complicate recovery after THR.
Awareness of this possibility can facilitate earlier recognition and initiation of
multidisciplinary treatment, which may lead to meaningful functional recovery and
improved quality of life.