Management of a broken modular femoral stem following total hip arthroplasty in a patient with sickle cell disease using an endofemoral trephine reamer: A case report.

ABSTRACT

INTRODUCTION AND IMPORTANCE Breakage of the femoral stem with intact bone is a rare complication that has only been reported once. Sickle cell disease (SCD) patients are more prone to variable complications due to the nature of their disease. We discuss how to safely remove a fixed broken stem using an intramedullary trephine reamer to achieve optimal outcome in a SCD patient. It is important to keep an intact femoral cortex during arthroplasty to achieve stable prostheses. CASE PRESENTATION We report a 35 years old SCD male, who complains of left hip pain and decreased activity 18-months following total hip arthroplasty with no history of trauma nor infection. Lab work and radiography showed signs of aseptic loosening and breakage of the femoral stem with no signs of cortical fractures. A trephine reamer was used to extract the stem during revision arthroplasty. Two years post-operative follow up showed improved Harris hip score (HHS) and apparent clinical improvement in function and pain. DISCUSSION: Multiple femoral stem extraction techniques have been reported in the literature. However, these approaches have variable disadvantages. Using the trephine reamer intramedullary helped to extract the distal femoral stem fragment and preserve the integrity of the femoral cortex. However, caution should be taken to avoid iatrogenic injuries. CONCLUSION: Using the trephine reamer to extract a broken femoral stem is a safe technique that preserves the cortical integrity. Complications of the trephine reamer include heat necrosis and iatrogenic fractures. Intra-operative measures can be taken to limit those complications.