Techniques for the Management of Failed Surgery for Fractures of the Neck of Femur

Case report: A 3-year follow-up study of simultaneous bilateral total hip arthroplasty for Femoral head necrosis in a patient with Kashin-Beck Disease

Introduction

Kashin-Beck Disease (KBD) is an endemic disease predominantly affecting joint and skeletal muscle, predisposing the articular cartilage to degeneration and necrosis. Currently,staged total hip arthroplasty is a common surgical method for advanced femoral head necrosis from KBD, but there are no reports in the literature on simultaneous bilateral total hip arthroplasty (SB-THA) for patients with KBD.

Case presentation

A 42-year-old male from Shaanxi Province, an endemic area, had bilateral hip pain for 4 years, with hips inversion and a crossed gait. After preoperative preparation, a SB-THA was performed by a posterolateral approach. Postoperative medication and functional exercises were administered and the patient was followed up for at least 3 years after discharge. The patient's hip mobility, hip scores and quality of life scores were recorded in detail during the follow-up.

Result

The patient stopped antibiotic treatment on the postoperative day-2, and all inflammatory indicators showed normal and started appropriate exercise, and the pain score decreased significantly. On the postoperative day-7, the patient had gradually adapted to various forms of rehabilitation exercises. He was discharged from the hospital on the postoperative day-10 and continued to be followed up. From the preoperative period to the last follow-up, the patient's bilateral hip mobility and functional scores improved significantly, and no adverse events such as hip pain, prosthesis loosening or dislocation were found at the last follow-up.

Conclusion

The patient's performance was satisfactory both intraoperatively and in the early postoperative period, but the hip scores and quality of life scores began to plateau or even decline from the third year after surgery to the last follow-up, probably due to the influence of further damage to articular cartilage in other parts of the body.

Bilateral Femoral Neck Stress Fracture in an Obese Middle-Aged Female With Osteomalacia and Coxa-Vara Managed by Simultaneous Bilateral Total Hip Arthroplasty

Femoral neck stress fractures in middle-aged individuals are usually associated with underlying metabolic bone disease. There is increased abnormal loading on femoral neck with associated coxa-vara and obesity in a female. Bilateral presentation of such fractures is rarely reported. Their management poses significant challenges. We present a case of bilateral femoral neck stress fracture in a 58-year-old obese housewife with compression type of the left hip fracture and tension type of the right hip fracture with non-union following an operated femoral neck stress fracture. She presented two months from the onset of symptoms and was treated with simultaneous bilateral total hip replacement for the management of her painful hips. Follow-up at 18 months revealed excellent outcome and return to independent painless daily routine activity. This report highlights the importance of early recognition of femoral neck stress fracture and challenges in the management of their late presentation. Total hip arthroplasty allows early mobilization with a favorable functional outcome.