Bilateral Insufficiency Fracture of the Pelvis Following THA: A Case Report

Insufficiency Fractures of the Distal Tibia and Fibula Following Total Hip Arthroplasty: A Case Report

Introduction:

Although periprosthetic fractures of the femur have been well documented, insufficiency fractures following total hip arthroplasty (THA) have been rarely described. We report a case of an insufficiency fracture in the distal tibia and fibula that occurred after THA.

Case Report:

A 54-year-old woman presented with severe pain in the bilateral hip joints and was diagnosed with end-stage osteoarthritis. She underwent THA on the right side. Although the postoperative course was uneventful, she suddenly experienced severe pain and swelling in the right leg without any history of trauma 22 weeks after the surgery. She was first diagnosed with cellulitis by her local doctor and was treated with oral antibiotics. Her symptoms persisted, and she returned to our hospital 1 month later. Her right distal leg and ankle were diffusely swollen and tender. Plain radiographs revealed a sclerotic linear zone in the distal tibia and fibula. She was diagnosed with insufficiency fractures in the distal tibia and fibula following THA. Local disuse osteoporosis and increased mechanical stress after THA as a result of pain relief could be the causes for her fracture. Her right leg and ankle were immobilized with a splint for another 4 weeks. Her symptoms subsided gradually, and fracture union was confirmed on the follow-up X-ray.

Conclusion:

Insufficiency fractures should be suspected in patients complaining of unexplainable pain, even in the distant area of the affected limb, for at least 6 months following THA

A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, following Hybrid Total Hip Arthroplasty

Introduction. Incidence of Exeter stem fracture is extremely uncommon. Pubic rami insufficiency fractures following arthroplasty are also rare. To our knowledge no cases of spontaneous stem failure with previous insufficiency fractures have yet been reported. Case Presentation. This report describes a case of spontaneous fracture through a cemented Exeter stem in a 66-year-old patient who had previously undergone a hybrid total hip replacement and was found to have bifocal pubic rami insufficiency fractures. The patient presented 18-year postprimary surgery with spontaneous fracture of the middle third of the cemented femoral stem and adjacent proximal femur. Conclusion. This report demonstrates a unique case of Exeter stem fracture with previous pelvic insufficiency fractures. The case adds to the rare occurrences of Exeter stem failure in the literature and highlights the risk of potential insufficiency fractures in patients undergoing total hip replacement.