A challenging sequence of ipsilateral femoral neck fracture, revision total hip arthroplasty, and periprosthetic femoral fracture in a transtibial amputee: a case report
César O. González-Cancino, Daniel A. Castañeda-Rincón, Raúl H. Muñoz-GómezIntroduction:
Patients with transtibial amputation may present gait asymmetry, altered load distribution, and increased risk of falls. Hip fracture treatment and arthroplasty in this population are uncommon and technically demanding.
Case presentation:
We report the case of a 59-year-old woman with systemic sclerosis, chronic corticosteroid exposure, osteopenia, and a prior left transtibial amputation secondary to severe vascular disease. Six months after the amputation, she sustained a displaced femoral neck fracture and underwent unipolar hemiarthroplasty at an outside institution. Persistent pain and poor functional recovery prompted conversion to total hip arthroplasty. Intraoperatively, femoral component retroversion was identified. Eighteen months later, she sustained a new fall resulting in a Vancouver type C periprosthetic femoral fracture, which was treated with open reduction and internal fixation. At 24 months after the last procedure, she had satisfactory pain relief, stable implants, fracture union, and functional ambulation with a prosthesis.
Discussion:
This case suggests that systemic fragility, altered biomechanics, recurrent falls, and technical factors may have interacted during this patient’s course. The observed sequence should be interpreted as a plausible multifactorial progression rather than a proven causal cascade.
Conclusion:
Hip arthroplasty in transtibial amputees requires careful preoperative planning, accurate component positioning, and attention to systemic risk factors such as poor bone quality and fall risk. Nevertheless, given the complexity and unique nature of this case, these recommendations should be considered cautiously, as they are based on a single clinical observation.