Complex primary total hip arthroplasty for nonunion of the right femoral neck in a female patient with right-sided hemiparesis: case report

Abstract

INTRODUCTION: Nonunion of the femoral neck (FN) is one most complicated hip joint (HJ) pathology, the surgical treatment of which by the total arthroplasty method is associated with a high percent of complications – periprosthetic fractures, endoprosthesis dislocations, postoperative hematomas, neurologic disorders. Analysis of the literature did not reveal generally accepted methods for determining the tactics of arthroplasty for FN nonunion, and the national Clinical Guidelines for this pathology are currently absent. To reduce the number of complications and increase the effectiveness of the total arthroplasty of the HJ in this group of patents, it seems important to be guided by the principles of stage-by-stage approach and pathogenetic justifiability in choosing treatment tactics.

AIM: To demonstrate using a clinical example the effectiveness of staged and pathogenetically justified tactics of total hip arthroplasty for nonunion of FN.

The article presents a clinical case of a 71-year-old female patient who had a past stroke with the outcome into the right-sided hemiparesis, and later, with the underlying neurologic deficit, suffered a pathological fracture of the neck of the right femur resulting in nonunion. On the primary examination, the patient stood upright with outside help and could stand in a rolling walker resting on the left leg. The patient could not walk. The Harris hip score was 24 points. The treatment tactics was based on the evaluation and correction of the five most significant nonunion components (osteoporosis, proximal displacement of the femoral bone, medial displacement of the femoral bone, hypotrophy of femoral and pelvic muscles, contractures of hip and unilateral knee joints), and included three stages preoperative preparation, arthroplasty proper and postoperative rehabilitation. The treatment result was satisfactory the hip endoprosthesis was implanted without complications, the anatomy of the limb was restored, the patient was activated on a walker. At examination 3 months after the operation, the Harris hip score was 53 points.

CONCLUSION: The presented clinical case illustrates the high effectiveness of the proposed staged and pathogenetically justified tactics of the total hip arthroplasty for nonunion of femoral neck.

Keywords

osteoporosis / muscle hypotrophy / nonunion / femoral neck / mechanotherapy / arthroplasty

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