Dataset Information

Acute Stress Fracture of the Pelvis after Total Hip Arthroplasty: A Case Report.

ABSTRACT: Acute hip pain following total hip arthroplasty (THA) could have numerous causes to include stress fracture of the pelvis. Stress fractures of the pelvis are rare and have been reported to involve the medial wall and the pubic ramus. A unique case is presented demonstrating the clinical presentation and management of an acute stress fracture of ilium and anterior column following a THA.A 72-year-old man underwent an uncomplicated right THA. He was noted to have femoral head resorption and thin osteoporotic bone intraoperatively. He initially did well postoperatively and ambulating without pain or assistive devices. Within 1 month of surgery, he returned with acute right hip pain without any traumatic event. Radiographs showed migration of the acetabular component and computed tomography scan confirmed a fracture through the ilium. The patient underwent revision surgery, where the fracture was reduced and internal fixation was achieved with a reconstruction plate and acetabular cage construct. At 9 months postoperatively, the patient remained pain-free with full weight bearing and with stable radiographs.Elderly patients who undergo THA may have low bone mineral density. These patients can develop stress fractures in their pelvis after surgery. These fractures may involve the medial wall, posterior column, or posterior wall. In patients who develop atraumatic pain postoperatively, it is important to consider for potential stress fractures of the ilium and evaluate appropriately with imaging. In these cases, revision surgery can be necessary to provide fixation of the stress fracture.

SUBMITTER: Akinbo O

PROVIDER: S-EPMC5553846 | biostudies-other | 2017 Mar-Apr

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description:ObjectivesTo determine whether the use of total hip arthroplasty (THA) among individuals with a displaced intracapsular fracture of the femoral neck is based on national guidelines or if there are systematic inequalities.DesignObservational cohort study using the National Hip Fracture Database (NHFD).SettingAll hospitals that treat adults with hip fractures in England, Wales, and Northern Ireland.ParticipantsPatients within the national database (all aged ≥60) who received operative treatment for a non-pathological displaced intracapsular hip fracture from 1 July 2011 to 31 April 2015.Main outcome measuresProvision of THA to patients considered eligible under criteria published by the National Institute for Health and Care Excellence (NICE).Results114 119 patients with hip fracture were included, 11 683 (10.2%) of whom underwent THA. Of those who satisfied the NICE criteria, 32% (6780) : received a THA. Of patients who underwent THA, 42% (4903) did not satisfy the NICE criteria. A recursive partitioning algorithm found that the NICE eligibility criteria did not optimally explain which patients underwent THA. A model with superior explanatory power drew distinctions that are not supported by NICE, which were an age cut off at 76 and a different ambulation cut off. Among patients who satisfied the NICE eligibility, the use of THA was less likely with higher age (odds ratio 0.88, 95% confidence interval 0.87 to 0.88), worsening abbreviated mental test scores (0.49 (0.41 to 0.58) for normal cognition v borderline cognitive impairment)), worsening American Society of Anesthesiologists score (0.74, 0.66 to 0.84), male sex (0.85, 0.77 to 0.93), worsening ambulatory status (0.32, 0.28 to 0.35 for walking with a stick v independent ambulation), and fifths of worsening socioeconomic area deprivation (0.76 (0.66 to 0.88) for least v most deprived fifth). Patients receiving treatment during the working week were more likely to receive THA than at the weekend (0.90, 0.83 to 0.98).ConclusionsThere are wide disparities in the use of THA among individuals with hip fractures, and compliance with NICE guidance is poor. Patients with higher levels of socioeconomic deprivation and those who require surgery at the weekend were less likely to receive THA. Inconsistent compliance with NICE recommendations means that the optimal treatment for older adults with hip fractures can depend on where and when they present to hospital.

Project description:Introduction and importance Pelvis reconstruction after tumor resection poses a challenge, especially in younger patients where preserving the patient's function and mobility is paramount. Case presentation A 16 years old female presented in March 2019 with vague right iliac area pain, diagnosed as pelvic Ewing's sarcoma after imaging studies (MRI and MSCT scan) and obtaining an incisional biopsy. After initial chemotherapy cycles, the tumor decreased in size, and surgical intervention in two stages was performed. The first stage was in October 2019 and consisted of pelvic resection type I and II according to Enneking and Dunham classification, proximal femur upshifting to compensate for the pelvic bone defect, and a cement spacer to fill the space of the resected proximal femur. The second stage was performed after two months and consisted of implanting a total hip arthroplasty using Megaprostheses and a cementless dual mobility acetabular cup. No local recurrence or distant metastases were detected during follow-ups. At the final follow up after 36 months, the patient showed acceptable functional outcomes (HHS score 83, and MSTS score 23 (76.7 %) points), and the radiographs showed proper implant positioning and stability. Clinical discussion Treating pelvic Ewing's sarcoma requires a multidisciplinary team. After surgical resection, the pelvic reconstruction options include using allografts or autografts, femur upshifting, and hemipelvis prostheses, which should be chosen considering patients and tumor characteristics as well as surgical team efficiency. Conclusion Reconstructing the pelvic defect after bone tumor resection by proximal femoral upshifting is a valid biological option with acceptable outcomes. Highlights • Pelvic reconstruction after bone tumor resection could be challenging• Various options for reconstruction, including biological and non-biological options• We utilized femoral upshifting combined with total hip arthroplasty for pelvic reconstruction post Ewing sarcoma resection.• Femoral upshifting with total hip arthroplasty provided acceptable functional outcomes and patient satisfaction.

Dataset Information

Acute Stress Fracture of the Pelvis after Total Hip Arthroplasty: A Case Report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets