Slullitel Pablo Ariel, Oñativia Jose Ignacio, Llano Lionel, Comba Fernando, Zanotti Gerardo, Piccaluga Francisco, Buttaro Martin Alejandro
Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
SICOT J. 2018;4:33. doi: 10.1051/sicotj/2018031. Epub 2018 Jul 30.
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 a stress fracture around a short cementless stem with cervico-metaphyseal fixation in an otherwise healthy patient. We implanted a MiniHip 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 to align the stem in order to equally distribute loads onto the medial calcar and the lateral femoral cortical.
尽管非骨水泥短柄假体具有理论上的优势，但术后大腿疼痛仍是一个值得关注的问题，且可能由不同原因引起。我们报告了一例特殊病例，在一位原本健康的患者中，采用颈干骺端固定的非骨水泥短柄假体周围发生了应力性骨折。我们为一名43岁的男性职业高尔夫球运动员植入了MiniHip柄，采用陶瓷对陶瓷关节面，用于治疗原发性骨关节炎。患者不听从医嘱，在术后第4个月开始踢足球，当时在该程度上完全无症状；但在8个月随访时，且无外伤史的情况下，他开始抱怨进行性髋关节疼痛。排除感染和假体松动后，骨活检的组织学分析证实了应力性骨折的诊断。尽管最初计划进行翻修手术，但通过保护性负重（使用拐杖），疼痛开始逐渐减轻，并在术后第一年左右消失，在随访2年半时患者仍无症状，X线片显示骨折愈合，有肥大性骨痂形成。我们鼓励外科医生意识到假体周围应力性骨折是大腿疼痛（有时难以处理）的一个原因，尽管这种情况不常见，但应始终予以考虑，前提是这些病例可以通过休息和限制负重进行保守治疗。在这例罕见病例之后，我们建议调整柄的位置，以便将负荷均匀分布在内侧骨距和外侧股骨皮质上。
