2019 Volume 38 Issue 1 Pages 43-47
Case: We report a case of femoral neck fracture in a patient with femoral bowing deformity. An 89-year-old lady had received bilateral total knee arthroplasties (TKAs) for osteoarthritis of the knee. The right side was operated eight years previously, and the left side was operated three months before presentation. Although she had been able to ambulate without pain, her left hip developed arthralgia resulting in an antalgic ambulatory posture from two weeks prior to visiting our outpatient clinic. At presentation, a radiographic study showed a left femoral neck fracture with Garden classification stage 4 accompanied with remarkable curvature deformation of her bilateral femurs. Bipolar THA using cement was performed for the left side. During rehabilitation, partial weight bearing (50%) was commenced one week postoperatively, and full weight bearing began from week two onwards. At six weeks postoperatively, she was able to ambulate on flat ground with a T-cane. When reviewed in our outpatient clinic at six months, she was able to walk unassisted and she could also climb stairs.
Discussion: While there are some reports that varus installation of stems with cement will not affect the results, there are also reports that cement will collapse at an early stage. There are also reports that cementless varus placement of stem has no influence in short- to mid-term results, and some other reports suggest that cementless varus placement leads to severe stress shielding, although this is still controversial. In the preoperative planning for this patient, we selected the varus insertion of the stem with cement because we were concerned that the tip of the stem would be in front of the lordosis or the outer curve at the intermediate insertion. Although good results were obtained in this case, long-term observation is necessary.
