Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

Abstract

Femoral neck stress fractures (FNSFs) can be treated conservatively or surgically, depending on initial displacement and patient condition. Surgical treatment options include internal fixation, with or without valgus osteotomy or hip arthroplasty, either hemi or total. The latter is mainly considered when initial treatment fails. A review of the literature shows that total hip arthroplasty (THA) is only considered as primary treatment in displaced fractures (type 3) in low-demand patients. We present a case of successive bilateral FNSF in a young active patient, where a THA was performed on one side, after failed internal fixation, and where it was chosen as primary treatment on the other side after failed conservative treatment.

Bilateral Femoral Neck Stress Fracture in an Obese Middle-Aged Female With Osteomalacia and Coxa-Vara Managed by Simultaneous Bilateral Total Hip Arthroplasty

“…Insufficiency fractures occur in the weak bone under normal loading. There are several risk factors for these fractures such as osteoporosis, osteomalacia, long-term corticosteroid and anticonvulsant treatment, renal osteodystrophy, amenorrhea, fluoride treatment, and pelvic irradiation [4][5][6][7]9].…”

“…Surgical treatment of late-presenting femoral neck stress fractures included either fracture fixation, valgus osteotomy or hip arthroplasty [5,7,11]. Fixation of femoral neck fractures is associated with a higher incidence of complications than any other fracture [11].…”

“…Fixation of femoral neck fractures is associated with a higher incidence of complications than any other fracture [11]. The reported incidence of avascular necrosis is 24% and non-union is 10% to 33% [1,2,5,11,12]. It is of paramount importance to evaluate the general condition of the patient, the fracture pattern, the implant selection amenable to fix that specific fracture, the surgical approaches, the anatomic reduction, and the technique of application of the implant to allow for early rehabilitation and mobilization.…”

“…In a recent review of literature on bilateral FNSFs, there are very few reports of arthroplasty in a middleaged patient treated by simultaneous THA for bilateral FNSFs [3,5]. There are no definitive suggestions regarding staged or simultaneous hip arthroplasty.…”

“…Bilateral FNSFs in middle-aged nonathletic individuals have been rarely reported [5]. Associated risk factors included abnormal anatomy, elderly females, seizures, renal osteodystrophy, long or short-term use of corticosteroid, amenorrhea, and osteomalacia [2][3][4][5][6]. Late presentation poses additional management challenges.…”