Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem

Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem

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Despite the theoretical advantages of uncemented short stems, postoperative thigh pain is still matter of concern and can be attributed to different causes.We report a peculiar case of read more a stress fracture around a short cementless stem with cervico-metaphyseal fixation in an otherwise healthy patient.We implanted a MiniHipTM stem in a 43 year-old male professional golf player for the treatment of primary osteoarthritis using a ceramic on ceramic bearing.

Against medical advice, the patient started to play soccer at the 4th postoperative month and was completely asymptomatic to that extent; but at 8 months follow-up and without a history of trauma he started complaining about progressive hip pain.After ruling out infection and loosening, histological analysis from a bone biopsy confirmed the diagnosis of stress fracture.Although revision surgery was initially scheduled, pain started to decrease gradually with protected weight-bearing (crutches) and disappeared around the first postoperative year, remaining the patient asymptomatic at 2 and half years of follow-up, with radiographs depicting a healed fracture with a hypertrophic callus.

We encourage surgeons to be aware of the existence of periprosthetic stress fractures as a source of thigh pain (sometimes intractable), and despite being infrequent, they should always be contemplated, providing that these cases can be managed conservatively with rest and limited weight-bearing.After this uncommon case, we suggest lochby venture pouch to align the stem in order to equally distribute loads onto the medial calcar and the lateral femoral cortical.