A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed 22 years earlier: a case report
© Kanda et al.; licensee BioMed Central. 2015
Received: 24 August 2014
Accepted: 8 December 2014
Published: 15 January 2015
Treatment of femoral neck fractures in young adults may require total hip arthroplasty or hip hemiarthroplasty using a bipolar cup. The latter can, however, result in migration of the femoral head and poor long-term results.
We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof. After bone union of the femoral shaft fracture, the patient was referred to our hospital for reconstruction of the acetabular roof. Intra-operatively, we placed two alloimplants of bone from around the transplanted femoral head into the weight-bearing region of the acetabular roof using an impaction bone graft method. We then implanted an acetabular roof reinforcement plate and a cemented polyethylene cup in the position of the original acetabular cup. Eighteen months post-operatively, X-rays showed union of the transplanted bone.
Treatment of femoral neck fractures in young adults is usually accomplished by osteosynthesis, but it may be complicated by femoral head avascular necrosis or by infection or osteomyelitis. In such cases, once an infection has subsided, either hip hemiarthroplasty using a bipolar cup or total hip arthroplasty may be required. However, if the acetabular side articular cartilage is damaged, a bipolar cup should not be used. Total hip arthroplasty should be performed to prevent migration of the implant.
KeywordsAcetabular articular cartilage Femoral head migration Femoral neck fracture Hemiarthroplasty Infection
Treatment of femoral neck fracture in young adults is usually accomplished by osteosynthesis, but treating patients with femoral head avascular necrosis or with infection or osteomyelitis is difficult. After resolution of infection, total hip arthroplasty or hemiarthroplasty of the hip joint using a bipolar cup may be required. However, the latter can result in migration of the femoral head and poor long-term results. We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient was 20 years old.
Treatment of femoral neck fracture in a young adult is usually accomplished by osteosynthesis. However, it is difficult to treat a patient with femoral head avascular necrosis, infection, or osteomyelitis.
After the infection subsided in our patient, we felt our only treatment option was hemiarthroplasty of the hip joint using a bipolar cup or total hip arthroplasty. For a femoral neck fracture without infection, hemiarthroplasty of the hip joint using a bipolar cup is reportedly not different from total hip arthroplasty . We obtained satisfactory results with hemiarthroplasty of the hip joint using a bipolar cup . However, this procedure can result in migration of the head and poor long-term results. Nakata et al.  reported a migration rate of 77% after hemiarthroplasty of the hip joint using a bipolar cup for secondary hip joint osteoarthrosis with acetabular dysplasia, as well as a higher migration rate in younger patients and those with a center-edge angle <0°. Tsumura et al.  found that patients who had hemiarthroplasty of the hip using a bipolar cup for avascular necrosis of the femoral head were categorized as Ficat stage II or III, whereas patients with avascular necrosis of the femoral head who were classified as stage IV had migration. Furthermore, when patients age 65 years or older or ambulatory patients age 75 years or older sustain a displaced femoral neck fracture, surgeons can expect total hip replacement to be better than hemiarthroplasty for the treatment of hip joint pain and erosion of the acetabular roof.
Total hip arthroplasty should be performed for a lesion on the acetabular roof, such as in rheumatism and osteoarthritis . In our patient, in whom the articular cartilage of the acetabulum was mostly normal and who had good movement of the outer head, hemiarthroplasty of the hip joint using a bipolar cup was sufficient. However, when the articular cartilage of the acetabulum is damaged, total hip arthroplasty, rather than hemiarthroplasty with a bipolar cup, should be used to prevent migration. The presence or absence of cartilage damage should determine the approach to treatment in these cases.
The treatment for a femoral neck fracture in a young adult is usually accomplished with osteosynthesis; however, difficulties may arise if there is accompanying infection, osteomyelitis, or femoral head avascular necrosis. When the acetabular articular cartilage is damaged, a bipolar cup should not be used; instead, total hip arthroplasty should be used to prevent migration. The presence or absence of cartilage damage should determine the approach to treatment in these cases.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors thank H Iwase for his assistance with this study.
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