Abstract
We present the case of a patient with Rheumatoid Arthritis who underwent a right total hip replacement as a young adult. At the time of surgery there was an intra-operative femoral fracture and the prosthesis and cement breached the cortex of the proximal femur postero-medially.
The fracture was detected on the post-operative film and the patient was treated non-operatively until the fracture consolidated. Despite having rheumatoid arthritis our patient went on to an active adult life having a family and she worked full time with this hip replacement. She subsequently required a socket revision at 15 years post index surgery and at the time the femoral component was well fixed, not scratched and left in situ.
Currently, the revision socket remains satisfactory, the stem still appears well fixed and clinically the patient is well.
Discussion: This case highlights the fact that not all intra-operative fractures require surgical intervention. They are low energy events with minimal soft tissue disruption and may heal satisfactorily. This case demonstrates that it should not be assumed that loosening and failure are inevitable.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
