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Introduction: Subchondral insufficiency fracture (SIF) of the femoral head has been reported to occur in older women with osteoporosis. No cases with recurrence of SIF at another site in the ipsilateral femoral head have been described. Case Report: We report a case of a 75-year-old woman with recurrent SIF at another site in the ipsilateral femoral head. SIF was first observed at an anterolateral site on the femoral head and treated non-operatively. The hip pain disappeared after 3 months but recurred 5 months later when another SIF was newly observed at a posterolateral-to-medial site on the femoral head. This SIF was also treated non-operatively. Five months later, the pain was alleviated, but progression of osteoarthritis was seen on X-rays. Conclusion: After an initial SIF, the possibility of recurrence should be considered if pain recurs, even on the ipsilateral side.
RESUMEN
AIMS: Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS: LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION: The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.
