Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review

Gianluca Canton; Giovanni Barbo; Roberto Roberto Fattori; Nicholas Nicholas Rasio; Luigi Murena

doi:10.23750/abm.v94iS2.13888

Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review

Authors

Gianluca Canton Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)
Giovanni Barbo University of Trieste
Roberto Roberto Fattori Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)
Nicholas Nicholas Rasio Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)
Luigi Murena Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)

DOI: https://doi.org/10.23750/abm.v94iS2.13888

Keywords:

Total hip arthroplasty, Femoral prosthesis neck fracture, Heterotopic ossification.

Abstract

Background and aim of the work: Fractures of the femoral stem neck are a rare complication in hip prosthetic surgery, especially in non-modular components. The authors report a case associated with massive heterotopic ossifications, with the purpose to analyze risk factors and specific characteristics. Methods: A case of femoral monobloc stem neck rupture is described. A non-systematic literature review regarding risk factors for femoral stem neck fracture was conducted in the PubMed database. Results: We report the case of a 61-year-old male who underwent surgery to remove calcifications four years after THA. Four months later the patient reported acute pain in the left hip, arising after a combined movement of external rotation and axial load while standing on the left foot, in the absence of any prodromic symptom. On radiographs, a displaced fracture of the neck of the hip prosthesis was revealed, together with massive heterotopic ossifications. After THA revision the patient’s symptoms were resolved. Conclusions: Prosthetic femoral neck fractures are a rare complication. We suggest that this case represents a unique type of fatigue rupture, where neck length and the presence of massive heterotopic calcifications contributed to flexion forces, resulting in failure in the midpoint of the neck.

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