Abstract
Introduction: Total hip arthroplasty (THA) has excellent stability and functionality in the treatment of neuropathic hip arthropathy. However, caution is required when performing surgery because of possible complications, such as dislocation and loosening. Here, we report our experience of a case in which THA was carried out for a patient with neuropathic hip osteoarthritis.
Case: A 50-year-old women complained of difficulty walking. In June 2004, she developed eyelid ptosis without a known trigger. The following month, she sought medical advice and she was hospitalized and diagnosed with neurosyphilis. Since August 2007, the patient had observed swelling extending from her right hip joint to her right thigh without any known cause, in addition to shortening of her right lower leg. Radiographic images showed a clear destruction of the femoral head. She was instructed to with respect to mobilizing, but eventually she began using a wheelchair. In February 2008, the patient attended her first examination at our hospital hoping for an operation to enable her to walk again unaided. Roentogen and computed tomography imaging showed that the right femoral head was destroyed and had almost disappeared. Moreover, bone destruction was evident around the load-bearing part of the acetabulum. Heterotopic ossification was also observed on the outer side of the acetabulum and outside the periphery of the greater trochanter. Magnetic resonance imaging revealed extensive hyperplasia of the joint capsule and synovium, with visible joint effusion. Although considerable destruction of the hip joint was observed in this case, the patient had no pain and the range of motion was mildly limited. Taking these findings together with her past history of neurosyphilis, we diagnosed her with a neuropathic hip joint and performed a THA. Although there is a high risk of dislocation in THA for neurogenic hip arthropathy, we were able to avoid this using an appropriate instrument with braces, thereby achieving a positive outcome.
