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Case Reports
. 2017 Mar 6;3(3):154-159.
doi: 10.1016/j.artd.2017.01.001. eCollection 2017 Sep.

Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology

Pablo Sanz-Ruiz  1 , Manuel Villanueva-Martinez  1 , Jose Antonio Calvo-Haro  1 , Esther Carbó-Laso  1 , Javier Vaquero-Martín  1
Affiliations
Case Reports

Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology

Pablo Sanz-Ruiz et al. Arthroplast Today. .

Abstract

Osteogenesis imperfecta (OI) is a rare congenital disease characterized by alterations in bone quality, with susceptibility to fractures, instability, deformities, and osteoarthrosis. Prosthetic surgery in these patients is associated with an abnormally high rate of implant failures. On the other hand, abnormal bone fragility adds to the complexity of revision surgery in such individuals-thus representing a genuine challenge for the orthopaedic surgeon. We present a case of femoral reconstruction in a patient with OI and prosthetic loosening after reconstruction secondary to femoral septic pseudoarthrosis. Intramedullary total femoral reconstruction was carried out after exceeding the biological reconstruction limits. This is the first reported instance of the use of an intramedullary total femur arthroplasty as salvage technique in an OI patient. This technique should be considered when we have exceeded biological limits for femoral fixation.

Keywords: Case report; Intramedullary femur prosthesis; Osteogenesis imperfecta; Revision hip arthroplasty; Teriparatide.

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Figures

Figure 1
Figure 1
Sinus tract on the lateral surface of the thigh (a); radiograph views showing disruption and the presence of pseudoarthrosis (b and c).
Figure 2
Figure 2
Views of first step surgery. Note the bone defect due to septic pseudoarthrosis (a and b), the segmental cement spacer (c) in the intraoperative views and X-ray control of the segmental spacer (d and e).
Figure 3
Figure 3
Intraoperative views of second step surgery. Observed in images a and b note the segmental bone defect after stem insertion. In images c and d note the reconstruction with cortical and morcellized allograft, in conjunction with a cable plate.
Figure 4
Figure 4
Postoperative views of second step surgery. (a) Two months after patient finished teriparatide treatment. (b) Five months after patient finished teriparatide treatment.
Figure 5
Figure 5
Intraoperative and postoperative views after replacement of the femoral component. Note stem extraction without signs of integration (a); trochlear bone defect due to stem protrusion (b); full length weightbearing x-ray (c) and lateral (d) view 2 years after surgery with out any signs of fracture, subsidence or loosening; clinical image of patient (e); He can walk with the help of two crutches.
See this image and copyright information in PMC

References

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