Zhao Xiangde, Wang Gangliang, Wang Yukang, Chen Jian
Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Key Laboratory of Mechanism Research and Precision Repair of Orthopaedic Trauma and Aging Diseases of Zhejiang Province, Hangzhou, Zhejiang, China.
Front Surg. 2025 Mar 18;12:1556599. doi: 10.3389/fsurg.2025.1556599. eCollection 2025.
Femoral neck fractures in transfemoral amputees are rare, and their management remains controversial, particularly in individuals with short residual limb lengths. Traditional approaches to total hip arthroplasty (THA), such as the anterolateral, Hardinge, and posterior methods, present significant challenges, including difficulties in residual limb manipulation, femoral exposure, and postoperative swelling. The direct anterior approach (DAA), a minimally invasive technique, has not been previously reported for THA in this patient population. This case report aims to evaluate the feasibility and outcomes of the DAA for THA in a transfemoral amputee with a femoral neck fracture.
We present the case of a 64-year-old Han male with an ipsilateral transfemoral amputation who sustained a femoral neck fracture. The patient underwent THA using the direct anterior approach. The DAA was selected due to its minimally invasive nature and ability to navigate through the intermuscular interval, which facilitated improved manipulation of the residual limb and easier exposure of the femoral side. Standard surgical protocols were followed, and postoperative care included monitoring for complications such as infection, thrombosis, and dislocation.
The patient's postoperative recovery was uneventful, with no signs of infection, thrombosis, dislocation, or other complications. Notably, there was no significant residual limb swelling, which was attributed to the minimally invasive nature of the DAA. The patient achieved unrestricted hip mobility without postural restrictions and attained a Harris Hip Score of 84.78 at follow-up, indicating a favorable functional outcome.
This case demonstrates the efficacy and safety of the direct anterior approach for total hip arthroplasty in patients with high above-knee amputations. The DAA effectively addresses many challenges associated with traditional approaches, such as residual limb manipulation, femoral exposure, and postoperative swelling. These findings suggest that the DAA is a viable alternative for managing femoral neck fractures in transfemoral amputees, warranting further investigation in larger studies to validate its broader applicability.
经股骨截肢患者的股骨颈骨折较为罕见，其治疗方法仍存在争议，尤其是对于残肢长度较短的患者。全髋关节置换术（THA）的传统入路，如前外侧入路、哈丁格入路和后入路，存在诸多显著挑战，包括残肢操作困难、股骨暴露困难以及术后肿胀等问题。直接前路入路（DAA）作为一种微创技术，此前尚未见在该患者群体中行THA的报道。本病例报告旨在评估DAA在一名股骨颈骨折的经股骨截肢患者中行THA的可行性及疗效。
我们报告了一例64岁汉族男性患者，其同侧经股骨截肢后发生股骨颈骨折。患者采用直接前路入路接受THA。选择DAA是因其微创特性以及能够通过肌间隙进行操作，这有利于改善残肢的操作并更轻松地暴露股骨侧。遵循标准手术方案，术后护理包括监测感染、血栓形成和脱位等并发症。
患者术后恢复顺利，未出现感染、血栓形成、脱位或其他并发症迹象。值得注意的是，没有明显的残肢肿胀，这归因于DAA的微创性质。患者实现了髋关节无限制活动，无姿势限制，随访时Harris髋关节评分为84.78分，表明功能预后良好。
本病例证明了直接前路入路在高位膝上截肢患者行全髋关节置换术中的有效性和安全性。DAA有效解决了与传统入路相关的许多挑战，如残肢操作、股骨暴露和术后肿胀等问题。这些发现表明，DAA是治疗经股骨截肢患者股骨颈骨折的一种可行替代方法，值得在更大规模研究中进一步探究以验证其更广泛的适用性。
