Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation

The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.

Bimodular femoral stems in primary total hip arthroplasty

INTRODUCTION

This review critically examines the efficacy of dual-modular stems in primary total hip arthroplasty. Given the variability and non-comparability of certain femoral stem designs and stem-neck couplings, with some even being withdrawn from the market, this review offers an in-depth analysis of predominant implant performances.

AREAS COVERED

The paper explores a brief historical summary related to dual-modular stems, including the complications associated with their use, diagnostic tools for evaluation, analysis of both recalled and currently available models, as well as alternative therapeutic options. This information is pertinent for both clinical and research domains.

EXPERT OPINION

While dual-modular systems were initially touted to offer several advantages, the evidence substantiating these benefits has been ambiguous. Further, these systems introduce the risk of alternative complications. In specific cases involving patients with developmental hip dysplasia and certain proximal femoral deformities requiring complex reconstructions, dual-modular systems might be relevant. Nonetheless, the use of long interchangeable necks in patients with a body mass index above 30 kg/m2 is discouraged, and pairing a long varus-oriented neck with an extra-long femoral head should be avoided in all patients.

Total Knee Replacement with an Uncemented Porous Tantalum Tibia Component: A Failure Analysis

Porous tantalum has been extensively used in orthopaedic surgery, including uncemented total knee arthroplasty (TKA). Favourable results were reported with earlier monobloc tibial components and the design evolved to modular implants. We aimed to analyse possible causes for extensive medial tibia bone loss, resulting in modular porous tantalum tibia baseplate fracture after primary TKA. Retrieved tissue samples were scanned with 3 MeV focused proton beam for Proton-Induced X-ray Emission (micro-PIXE) elemental analysis. Fractographic and microstructural analysis were performed by stereomicroscopy. A full 3D finite-element model was made for numerical analysis of stress-strain conditions of the tibial baseplate. Histological examination of tissue underneath the broken part of the tibial baseplate revealed dark-stained metal debris, which was confirmed by micro-PIXE to consist of tantalum and titanium. Fractographic analysis and tensile testing showed that the failure of the tibial baseplate fulfilled the criteria of a typical fatigue fracture. Microstructural analysis of the contact surface revealed signs of bone ingrowth in 22.5% of the surface only and was even less pronounced in the medial half of the tibial baseplate. Further studies are needed to confirm the responsibility of metal debris for an increased bone absorption leading to catastrophic tibial tray failure.

Interchangeable neck failures of bi-modular femoral stems in primary total hip arthroplasty cannot be predicted from serum trace element analysis

INTRODUCTION

Revision of a well-fixed stem due to unexpected modular neck fracture is a catastrophe for the patient and a challenge for the surgeon. This study aimed to test the possibility of predicting interchangeable neck fracture from serum levels of the stem/neck alloy-consisting metals.

MATERIALS AND METHODS

Nineteen patients at high risk for interchangeable neck fracture were randomly selected out of a cohort of 680 bimodular stems made from Ti6Al4V alloy. Serum levels of titanium, aluminium and vanadium were determined. Nine age- and gender-matched patients were used as controls.

RESULTS

Mean serum levels of Ti were 6.04 ± 2.52 μg/L, of Al 3.89 ± 1.68 μg/L and of V 0.07 ± 0.04 μg/L in the high-risk group, and 8.22 ± 4.74 μg/L, 4.99 ± 3.98 μg/L and 0.27 ± 0.44 μg/L in the low-risk group, respectively. No statistically significant differences were found between the groups.

DISCUSSION

Interchangeable neck fracture of bimodular femoral stems cannot be predicted from serum trace element analysis.

Modular femoral neck failure after revision of a total hip arthroplasty: a finite element analysis

The authors report on a case of modular femoral neck fracture which appeared 21 months after revision of acetabular component. The revision surgery was performed 8 years after the primary total hip arthroplasty due to aseptic loosening of the acetabular component. During acetabular revision, the primary implanted short (S, - 3.5 mm) femoral head was also exchanged with extra-long (XL, + 7.0 mm) femoral head fitting the modular femoral neck with a longer lever arm. Numerical analysis has shown that this has resulted in a 19.9% increase in tensile stress at the neck-stem coupling during normal walking cycle. This could result in microcrack initiation and propagation and finally lead to modular neck failure of the otherwise well-fixed stem. Surgeons should avoid excessive loading of the exchangeable neck (dual-modular) femoral stem designs as the stem-neck couplings are subject to corrosion and are not as reliable as monoblock stems.

Why do some titanium-alloy total hip arthroplasty modular necks fail?

BACKGROUND

Increased modularity in total hip arthroplasty (THA) through extra junction between the neck and the femoral stem is gaining popularity among orthopaedic community. However, the advantage of the additional junction is shadowed by an increased risk of mechanical failure. The aim of this study was to describe the exact mechanism of fracture of the modular femoral neck in an uncemented stem.

METHODS

Clinical, metallurgical, and mechanical analysis including finite-element modelling and elemental-sensitive tissue analysis with the micro-PIXE method was performed on two patients treated with fully modular primary THA made from Titanium alloy of the same oval taper-cone design. In patient A revision was performed 7.8 years after the unilateral primary procedure because of modular femoral neck fracture, while patient B was left-side revised 15 years after the bilateral primary procedure because of aseptic loosening of the femoral stem.

RESULTS

Body weight was 30% higher and the arm of implanted modular femoral neck was 51% longer in patient A compared to patient B. Therefore, the stress ratio on the modular femoral neck of patient A was calculated to be 2.45 times higher than in patient B, preventing cold welding and producing taper damage and degradation at the neck-stem junction. Large clusters of metallic debris containing Titanium and Vanadium from the alloy were present in the periprosthetic soft tissues of patient A.

CONCLUSIONS

Patients with higher body mass index treated with fully modular Ti-alloy THA may be at increased risk to experience catastrophic failure of the device. Orthopaedic surgeons should avoid using long necks whenever possible, as these are especially prone to develop a vicious circle starting with the fretting process and crevice corrosion at the taper-cone connection, leading to crack initiation and crack propagation, accelerated by the increased vulnerability of the Ti-alloy in biologic media, ultimately ending as fracture at the typical site. Serum Ti concentration may represent a rough estimation of taper degradation and patients with elevated levels should be warned and followed accordingly.

Total hip arthroplasty-related osteogenic osteosarcoma: case report and review of the literature

BACKGROUND

Orthopedic implant-related sarcoma is an exceedingly rare, but a known complication of total hip arthroplasty (THA).

CASE PRESENTATION

The authors describe clinical and radiologic features, histologic appearance, and treatment of osteogenic osteosarcoma located in the proximal femoral diaphysis associated with an unstable femoral prosthesis following THA in a 65-year-old male patient. The patient with HLA-B27 positive ankylosing spondylitis underwent arthroplasty 15 years ago.

CONCLUSIONS

The neoplastic process may be considered as an extraordinary complication of THA and might just be coincidental or the result of some derangement of the healing process in host tissue with no definitely proven hypothesis that the implants or their by-products are carcinogenic. The soluble chemical substances from the implanted prosthetic material are, at least in animals, suspected to play a vital role in the pathogenesis of the neoplastic transformation of the bone tissue. The presented case shall alert orthopedic surgeons to clinical, radiologic, and macroscopic similarities between a malignant tumor and benign lesions caused by wear debris at THA sites. At the examination of plane X-rays of patients with THA loosening, the differential diagnosis should always include osteogenic sarcoma, as well. To our knowledge, there have been only nine cases of THA-related osteogenic osteosarcomas described in the English-language literature.

Results of total hip arthroplasty using a bionic hip stem

PURPOSE

The trabecular-orientated bionic hip stem was designed to mimic the natural force transmission through the femur in total hip arthroplasty, resulting in supposedly longer prosthesis survivability. The aim of this study was to compare the second-generation bionic hip stem to a standard uncemented hip stem.

METHODS

A group of 18 patients (21 hips) who underwent total hip arthroplasty with a bionic stem (bionic group) was compared with a historic group of 12 patients (12 hips) treated with standard anatomic hip stem (control group). During the first year after the procedure, the densitometric measurements of the bone around the prosthesis were taken. Radiographic and clinical assessments were additionally performed preoperatively and at the three month, six month, one year and three year follow-ups in the bionic group.

RESULTS

In the bionic group, one patient was revised for aseptic loosening and 16 patients (19 hips) were available to the final follow-up. A significant decrease of bone mineral density was found in Gruen zones 3, 4 and 5 in the bionic group, and in zone 7 in both groups. The bionic group had a significantly higher bone mineral density in Gruen zone 1 at the one year follow-up. At the final follow-up, all prostheses were radiologically stable in both groups.

CONCLUSIONS

Provided that a good implant position is achieved, comparable short-term results can be obtained using a bionic stem. Still, a decrease of bone mineral density in Gruen zone 7 occurred in both groups. Further studies are required to determine survivability of the bionic stem.

Dynamic versus rigid stabilization for the treatment of disc degeneration in the lumbar spine

Study design: Retrospective cohort study.

Clinical question: This study aimed to describe the outcome of stabilization surgery with dynamic instrumentation for degenerative disc disease. The results were compared with age- and gender-matched peers treated with traditional fusion with rigid instrumentation. If necessary, additional nerve elements decompression was undertaken in both groups.

Methods: This study analyzed the success rates of 25 patients aged 47.4 years (mean 95% confidence interval: 43.1–51.7) treated with stabilization of the involved vertebral dynamic unit(s) with either dynamic or rigid instrumentation with or without additional decompression. Clinical outcome was assessed with Oswestry disability index (ODI) and visual analogue scale (VAS) for back pain, leg pain, and activity level. Satisfaction outcome was measured with Stauffer and Coventry overall satisfaction criteria and VAS for satisfaction. Health-related quality of life was estimated with Short Form-36 (SF-36) questionnaires. Fusion rate and adjacent level(s) was checked with x-ray. Complications recorded in patients' files were evaluated and revision surgeries were stated as treatment failures.

Results: At the 4-year follow-up (range, 2–5 years) significant improvement was noted on some subjective parameters in both groups. No statistical differences were seen between the groups at final follow-up. Five patients (42%) in the rigid group and two patients (20%) in the dynamic group were rated good or excellent according to the overall Stauffer and Coventry satisfaction criteria. Radiologically, seven patients (58%) in the rigid group were undoubtedly fused and all the involved discs in the dynamic group continued to degenerate. Adjacent segments showed loss of disc height in both groups but only loss of upper adjacent discs in the rigid group was statistically significant. Two patients in the dynamic group and one patient in the rigid group required reoperation because of the pedicle screw misplacement.

Conclusion: The results of this study indicate no significant difference between dynamic and rigid stabilization of the lumbar spine for patients with degenerative disc disease (DDD). However, the study is underpowered and further studies on larger and homogeneous group of patients should be undertaken.

Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty

The aims of this study were to determine (1) whether the duration of closed suction drainage affects the occurrence and duration of prolonged serous drainage and (2) if closed suction drains could be omitted according to the wound and/or thigh appearance after unilateral primary total hip arthroplasty. One hundred thirty-nine patients undergoing total hip arthroplasty were randomized into 3 groups: 42 patients received no drainage, 46 patients received drainage for 24 hours, and 51 patients received drainage for 48 hours. No differences with respect to occurrence and duration of prolonged serous drainage were found between the 2 groups with drains. Although no prolonged serous drainage occurred, the swelling of the thigh was significantly greater (P < .001) and the occurrence of prolonged thigh pain was significantly higher (P = .01) in the group without drainage.

Postmenopausal vaginal atrophy correlates with decreased estradiol and body mass index and does not depend on the time since menopause

OBJECTIVE

To evaluate the relationship between morphologic cell characteristics in Papanicolaou (Pap) smears and serum estradiol, body mass index (BMI) and the time elapsed since menopause. Study design. In 92 women Pap smears were grouped into atrophic and mature cell patterns and compared with estradiol, BMI and the time since menopause.

RESULTS

Forty-one patients with mature cell pattern were on average 7.1 years from menopause and 51 patients with atrophic pattern 8.2 years, but this difference was not significant. Estradiol in patients with mature cell pattern was significantly higher (52.1 +/- 48.5 pmol/l) than in patients with atrophic pattern (25.6 +/- 40.0 pmol/l). Similarly, BMI was significantly higher (27.9 +/- 4.2 kg/m(2)) in patients with mature cell pattern than in patients with atrophic pattern (25.7 +/- 3.8 kg/m(2)). There was no significant correlation between the time since menopause and estradiol among patients with mature and atrophic cell pattern. The same was true for the correlation between the time from menopause and BMI in patients with mature and atrophic pattern.

CONCLUSIONS

Estradiol and BMI are associated with vaginal cell maturation and atrophy in postmenopausal women. Vaginal cell atrophy does not depend on the time since menopause.

Osteopenia and osteoporosis can be predicted from Pap test

OBJECTIVE

To determine sensitivity and specificity of Pap tests for osteopenia and osteoporosis using bone mineral density (BMD) with dual x-ray absorptiometry (DXA) as the reference standard.

STUDY DESIGN

DXA measurement was performed on 136 routine Pap smears. Results of DXA measurement were expressed in T-scores, indicating degree of deviation compared to a young adult population of same age and gender. Smears were grouped into atrophic and mature cell patterns. Using a stereologic analysis, mean areas of squamous cells, their nuclei and their cytoplasm were estimated.

RESULTS

There was significant positive correlation between cell area and T-score (p < 0.001), as well as between cytoplasm area and T-score (p < 0.001). There was no significant relationship between nucleus area and T-score (p > 0.05). Mean T-scores of patients with atrophic cells were significantly lower than mean T-scores of patients with mature cell patterns (p < 0.001). The group including patients with atrophic or mature cells had a sensitivity of 61.4% and specificity of 86.4%, with positive predictive value of 95.9% in detecting patients with osteopenia or osteoporosis.

CONCLUSION

Women with atrophic smear pattern are susceptible to osteopenia or osteoporosis; many cases could be detected with routine Pap test without additional costs.

Relationships between bone mineral density and cell size in cervical smears, serum estradiol levels, and anthropometric characteristics

OBJECTIVE

To evaluate relationships between bone mineral density and morphometric characteristics of squamous cells in cervical smears, serum estradiol levels, body weight, and body mass index.

METHOD

Dual X-ray absorptiometry measurements were performed in 107 women who had recently undergone routine screening for cervical cancer. Serum estradiol levels were determined. Mean areas for squamous cells, squamous cell nuclei, and squamous cell cytoplasm were calculated, as well as the nucleus area to cytoplasm area ratio.

RESULTS

The mean cell and cytoplasmic areas were significantly lower in women with lower T scores for femoral neck and lumbar spine (P<0.001). Mean T scores were significantly lower for the women with atrophic cells than for those with mature cells (P<0.001). A correlation between estradiol levels and T scores was found for the lumbar spine (P<0.05) but not for the femoral neck. Multiple linear regression analysis showed the cytoplasmic area to be the most significant predictor of T scores for the total hip, followed by BMI and age, and to be the only significant predictor of T scores for the total spine.

CONCLUSION

Relationships were found between bone mineral density and both the total cell and cytoplasmic areas of squamous cells obtained from cervical smears.

Effect of etidronate in preventing periprosthetic bone loss following cemented hip arthroplasty: A randomized, double blind, controlled trial

INTRODUCTION

Periprosthetic bone loss occurs after insertion of a total hip prosthesis and is often a result of stress shielding or altered loading of the proximal femur. Preventing the bone loss, which may threaten the prosthesis survival, with an antiresorptive drug would be highly advantageous.

MATERIALS AND METHODS

Our study investigated the effect of cyclic etidronate therapy on periprosthetic, contralateral hip, and spine bone mineral density (BMD) in a one-year, prospective, randomized, double-blind study in 31 patients after cemented hip arthroplasty. Etidronate was taken orally in a regimen repeated every 14 weeks, and periprosthetic BMD was measured with dual energy X-ray absorptiometry (DXA) in the total periprosthetic area and in the seven Gruen zones at 1 week (baseline), 6 weeks, 3 months, 6 months, and 12 months postoperatively.

RESULTS

In the etidronate group there were significant temporal BMD decreases measured in Gruen zones 2, 3, 6, and 7 and in the entire proximal femur; the greatest decrease was 12.9% and was measured in zone 7 at six months. Also in the etidronate group, there was a significant 2.8% temporal BMD increase in the spine at 12 months. In the placebo group there were significant temporal BMD decreases measured in Gruen zones 1, 2, 3, 5, 6, and 7 and in the entire proximal femur; the greatest decrease was 25.5% and was measured in zone 7 at 12 months. There were no significant differences between the mean BMD measurements of the etidronate and placebo groups.

CONCLUSION

These findings suggest that cyclic etidronate therapy has no significant effect in suppressing periprosthetic bone loss after cemented hip arthroplasty.

Long-term results after open Bankart operation for anterior shoulder instability. A 3- to 16-year follow-up

The open Bankart procedure is still considered the gold standard for patients with recurrent posttraumatic anterior shoulder instability. The purpose of this retrospective study was to analyze long-term results after open Bankart procedure in 83 patients that were operated between 1987 and 2000 and to evaluate the rate of recurrent instability, level of function and range of motion. The mean follow-up time was 9 (3-16) years. The postoperative recurrence rate including subluxations was 12%. The mean Constant score was 77 and the mean Rowe score was 63. Average loss of external rotation in 90 degrees of abduction was 19 degrees . The results were disappointing in terms of stability and function. In the absence of longterm prospective studies on newer arthroscopic techniques, the decision on the reconstruction method must still be based on the surgeon's experience and the patient's choice.

Patient-based outcomes for the operative treatment of degenerative lumbar spinal stenosis

STUDY DESIGN

A retrospective surgical case series was conducted using a condition-specific, patient-based outcomes assessment.

OBJECTIVE

The goal of this study was to describe the outcome predictors of decompressive surgery for degenerative lumbar spinal stenosis (DLSS).

SUMMARY OF BACKGROUND DATA

Surgical decompression is the recommended treatment for patients with moderate to severe DLSS. Previous studies have reported that factors such as the number of operated levels and patient health status are predictors of surgical outcomes.

METHODS

This study analyzed the success rates of 58 DLSS patients treated with decompressive surgery. Outcomes were measured with the Zurich Claudication Questionnaire (ZCQ) completed pre-operatively and at least 12 months post-operatively (range 12-54 months). The ZCQ includes three distinct domains that involve symptom severity, physical function, and patient satisfaction. Variables such as age, sex, pre-operative symptom severity, and arthrodesis were analyzed as predictors of success.

RESULTS

The study group included 21 males and 37 females, and the mean age of all patients was 66 years (range 41-80 years). Overall, 63.8% of the patients had significant clinical improvement in Symptom Severity, 55.2% had significant clinical improvement in Physical Function, and 58.6% of the patients were at least somewhat satisfied; 63.8% (37/58) of the patients were considered to be clinically successful. Patients with more severe pre-operative symptoms and more physical function restrictions had better success results than those patients with milder symptoms and less restrictive physical function. Also, patients who were followed for less than 24 months had better success than those followed for more than 24 months. There was no significant difference in the clinical success rates of (1) patients who were fused and those not fused, (2) males and females, (3) patients aged less than 65 years and those greater than 65 years, and (4) patients who were treated at one or two levels and those treated at three or four levels.

CONCLUSION

The results of this retrospective study indicate that operative decompression of the lumbar spine offers significant improvement for patients with DLSS. Although not all comparisons were statistically significant, there was a trend for DLLS patients aged less than 65 years with more severe pre-operative symptoms and physical function disturbances treated at one or two levels with a laminectomy and fusion to have the best outcomes.

Etidronate does not suppress periprosthetic bone loss following cemented hip arthroplasty

Periprosthetic bone loss after arthroplasty may threaten prosthesis survival. The current study investigated the effect of etidronate therapy on periprosthetic, contralateral hip, and spine bone mineral density (BMD) in a one-year, prospective, randomized, double-blind study on 46 patients after cemented hip arthroplasty. BMD was measured with dual-energy X-ray absorptiometry (DXA). There were no significant differences between mean BMD measurements of the etidronate and placebo groups, with the exception of the mean percent change in the spine at six months and 12 months and in Gruen zone 3 at six months; in all three cases, the etidronate group had significantly greater mean values. These findings suggest that cyclic etidronate therapy has no significant effect in suppressing periprosthetic bone loss following cemented hip arthroplasty.

Morphological analysis of squamous cells in routine Pap smears as a predictor of bone mineral density in asymptomatic women

OBJECTIVE

The present study attempted to find out possible coherence between morphologic characteristics in Pap smears and bone mineral density (BMD) as measured by DEXA.

STUDY DESIGN

DEXA measurement (with the result expressed as T-score) was performed in 79 women in whom Pap smears for routine cervical cancer screening were obtained. The smears were grouped into atrophic and mature cell patterns. Using astereological analysis, the mean areas of squamous cells, their nuclei and cytoplasm were estimated.

RESULTS

The mean areas of cells and cytoplasm were significantly lower at lower T-scores (P < 0.01), while the mean areas of nuclei were not (P > 0.5). T-scores were significantly lower in the atrophic cell pattern group (P < 0.001). The study group indicated concurrently high sensitivity of 80.9% and specificity of 78.1%, with positive predictive value of 84.4%.

CONCLUSION

These results suggest that a significant number of women with low BMD could be identified parallel with the routine Pap test for cervical cancer screening without additional costs.

Functional and electromyographic results after open rotator cuff repair

Fifty-one patients treated for full-thickness rotator cuff tears were followed up an average of 4 years after surgery (range, 2-6.4 years). The shoulder function was assessed according to the Constant classification, each patient did strength measurements, and had electromyographic evaluation of the supraspinatus and infraspinatus muscles. The mean value of the Constant score for the surgically treated shoulder was 2.7 points. Forty-five patients (88.2%) had satisfactory scores and six patients (11.8%) had unsatisfactory scores. The result of treatment was significantly correlated to the size of the tear and the time elapsed from injury to surgery. However, no correlation was found between the result of the treatment and the type of surgery, mode of postoperative rehabilitation, and age. The strength measurement of abduction and of external rotation indicated significantly reduced power in surgically treated shoulders compared with contralateral shoulders. There was a significant difference of the infraspinatus motor unit potential interference pattern reduction between surgically treated and the contralateral shoulder. There was a positive correlation between electromyographic findings and the results of rotator cuff reconstruction.

Late results of modified Mitchell procedure for the treatment of hallux valgus

From a total of 153 patients (251 feet), 64 (41.8%) patients, who had had 105 modified Mitchell procedures, were clinically and radiographically examined with follow-up periods ranging from 15 to 24 years (mean, 21 years). Mean age at operation was 41 years (range, 12-64 years). The classic double osteotomies, which diverged slightly toward the plantar surface and the distal fragment, shifted laterally, and angled plantarward, were fixed with a smooth Kirschner wire. In this way, it was possible to achieve a reduction in the first intermetatarsal angle from an average of 22.5 degrees preoperatively to 7.7 degrees postoperatively, and the hallux valgus angle changed from an average of 33 degrees to 17 degrees, with an average shortening of the first metatarsal of 5.4 mm and an average lateral displacement of the first metatarsal head of 4.5 mm. In 67 feet (64%), the results were graded good to excellent; in 23 feet (22%), satisfied; and in 15 feet (14%), poor. The results were worse than the results obtained on the same patient population with a follow-up ranging from 2 to 11 years, with 97% good-to-excellent results reported. Pain over bunion caused by recurrence of the hallux valgus deformity was the main reason for this late deterioration of the results.

Displaced subcapital fracture of the hip in transient osteoporosis of pregnancy. A case report

We describe a case of displaced subcapital fracture of the hip in a woman in the third trimester of her first pregnancy. A pathological fracture occurred in a previously painful hip, and radiographs showed pronounced osteopenia of the femoral head and neck. Closed reduction and internal fixation was carried out 2 weeks after delivery when the osteopenia was still severe. Healing of the fracture followed with recovery of hip movements.