“Priya came under my care as an emergency case. She was 82 when she suffered a sudden left thigh pain leaving her unable to walk or stand. This was on a background of a left total hip replacement in 2000 which had been very successful allowing her to live unaided, drive, travel and keep fit. In 2016 she fell and suffered a periprosthetic fracture of her left total hip replacement which was managed with a plate.
Unfortunately this plate had failed, leading to her presenting symptoms. This left us with a very complicated left femur to reconstruct.”
Clinical examination was very difficult. Priya was bed-bound and unable to mobilise. All left leg movements were painful but neurologically there were no concerns and all of her distal pulses were present. She had no signs of infection and no signs of vascular compromise.
Anteroposterior plain radiograph of the left hip taken before I met Priya. This was taken after he periprosthetic fracture of the left proximal femur was plated.
Anteroposterior plain radiograph taken three months after her periprosthetic fracture was plated. It demonstrates a fracture of the femoral plate, at the tip of the stem which has opened up her previous periprosthetic fracture.
A periprosthetic fracture at the tip of the left femoral stem with broken femoral plates.
For Priya, the only way to reconstruct her complex periprosthetic fracture was with a proximal femoral replacement. We planned to remove all of her metal work surround the left hip, perform a proximal femoral replacement and retain the left acetabular socket.
To be checked by PROF
To be completed by ROB
Anteroposterior and lateral plain radiographs demonstrating the proximal femoral replacement in situ with the existing cemented acetabular cup in place. This image was taken immediately after the procedure.
Priya had a very good outcome. She was up and mobilising with the physiotherapists the day after her operation.
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.
To be checked by PROF.
Evidence for this Treatment
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