Management of infected nonunion neck of femur fracture on an ipsilateral above knee amputation limb planned for total hip arthroplasty
Sarbhjit Singh Lakha Singh, Prabu Supramaniam, Muhammad Fadhil B. Mat Salleh, Muhammad Azhar Abdullah, Ahmad Fauzey KassimBackground
Total hip arthroplasty (THA) is widely used to alleviate pain and restore mobility in patients with advanced hip pathologies. However, performing THA in patients with ipsilateral above-knee amputations (AKA) complicated by infected nonunion neck of femur fractures and avascular necrosis (AVN) presents significant challenges. These include addressing infection control, anatomical alterations, and increased mechanical demands on implants.
Case Presentation
We report a case of a 22-year-old male with an ipsilateral AKA following a motor vehicle accident, which resulted in a closed neck of femur fracture, open supracondylar femur fracture, and open midshaft tibia fracture. Initial surgical management involved screw fixation and external fixation; however, subsequent gangrene necessitated AKA. Persistent infection at the femoral neck site was treated with multiple debridement procedures, antibiotic therapy, and first-stage revision surgery using an antibiotic-loaded cement spacer. After confirming infection eradication via negative cultures and a low CRP level, second-stage revision THA was performed. A dual-mobility liner and cemented femoral stem were utilized because of osteopenia and concerns over abductor muscle integrity. Postoperatively, the patient demonstrated excellent functional recovery and regained independent mobility with the prosthesis.
Discussion
THA in patients with ipsilateral AKA poses unique surgical challenges including stump manipulation, femoral preparation, and infection control. Two-stage revision surgery remains the gold standard for managing chronic infections, and a multidisciplinary approach is critical for success. Dual-mobility implants and precise preoperative planning are key to achieving stability and function in such cases.
Conclusion
This case highlights the feasibility and positive outcomes of THA in complex scenarios involving the ipsilateral AKA and infection. Meticulous infection management, careful implant selection, and individualized rehabilitation plans are pivotal in achieving functional recovery and improving quality of life. This report underscores the importance of a tailored approach in managing such challenging cases.