Clinical History, Examination and Blood Test Results

  • Step 6 case 2 is an 82-year-old female who presented as an emergency with sudden left thigh pain and inability to walk or stand. She underwent left hip replacement in 2000 and able to keep fit, live unaided, drive and travel. In December 2016 she fell and suffered a periprosthetic fracture which was plated.

  • Examination revealed her to be bed-bound. All movements of the left leg were painful. She had no neurological signs in her left leg, her pulse was intact and there were no skin ulcers.

  • Blood inflammatory markers were normal


Imaging Results

PRE-OP RADIOGRAPH (DECEMBER 2016)

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PRE-OP RADIOGRAPH (FEBRUARY 2017)

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This radiograph of the left femur shows the original periprosthetic fracture which was plated in 2016.

This radiograph of the left femur showed fracture of a femoral plate, at the tip of the stem and opening up of her previous periprosthetic fracture. The cemented polyethylene cup looked well fixed, with minimal surrounding bone and the cement protruded into the pelvis


Diagnosis

  • A periprosthetic fracture at the tip of her femoral stem with broken femoral plates.


Treatment

  • Removal of all metal work, proximal femoral replacement and retention of the left acetabular socket.


Imaging Outcomes

POST-OP RADIOGRAPHS

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This anteroposterior radiograph of the pelvis shows the proximal femoral replacement in situ with the existing cemented acetabular cup.

This anteroposterior radiograph of the left hip demonstrates the size of the proximal femoral replacement.

This radiograph of the distal femur shows the distal stem and cement mantle of the implant. Note the post-operative staples.


Clinical Outcomes

  • She was able to mobilise, weight bearing, the day after surgery.


Learning Points

  • When there is extensive damage to the periprosthetic bone stock you are left with little option but to replace the whole of the proximal femur. This maybe less traumatic than trying to preserve the proximal femur and allows weight bearing immediately after surgery.