Description

Periprosthetic fractures are a well-recognized complication of joint arthroplasty, with an increased risk in the long-term follow-up of joint replacements. In a long-standing bipolar hemiarthroplasty case, we highlight the management challenges of a displaced periprosthetic fracture and difficult implant removal.

A 55-year-old male presented with a displaced periprosthetic fracture. He was operated on 12-years ago with cemented bipolar hemiarthroplasty for the neck-femur fracture of the left hip. Radiographic evaluation revealed a displaced Vancouver B3 periprosthetic fracture with severe osteopenia and pronounced stem loosening, and the distal part of the stem displaced medially with calcifications around the tip of the stem.

Management: Given the patient’s age, fracture pattern, bone quality, and construct loosening, infection was ruled out, and the decision was made to proceed with the removal of the bipolar prosthesis. The patient underwent a removal of the prosthesis, and postoperatively, the patient was made to bear weight as tolerated and is awaiting a staged revision arthroplasty.

Periprosthetic fractures in long-term hip arthroplasties can be challenging to manage, often requiring implant removal and staged revisions. This case illustrates the importance of careful preoperative planning, consideration of patient factors, and a pragmatic approach to achieving a stable construct and restoring function in these complex clinical scenarios.

Figure 1: Clinical image.