Simultaneous above-knee amputation and ipsilateral total hip arthroplasty in a neglected neck of femur fracture with an insensate limb.

ABSTRACT

Total hip arthroplasty (THA) in patients with ipsilateral mid-thigh amputation is surgically challenging. We report a case of same setting THA and ipsilateral above-knee amputation in a male patient. The patient had 8 months old neglected neck femur fracture and ipsilateral femur shaft fracture with 14 cm bone loss. There was an associated neurovascular (femoral artery injury and sciatic nerve palsy) deficit at the initial insult; however, the limb survived because of well-formed collaterals. The limb was insensate at the time of presentation because of complete sciatic nerve palsy. The decision to undergo amputation was taken based on insensate limb, compromised circulation and huge bone loss with healed open fracture. After 10 months follow-up, the patient was walking with prosthesis limb fitted to the amputated mid-thigh stump and there were no incidences of osteolysis, subsidence or infection in the THA site.