Periprosthetic fracture of total hip replacement in patients with osteopetrosis: A case presentation and review of literature.

Abstract

Osteopetrosis is a rare inherited bone disease characterized by impaired osteoclast activity. Total joint replacement is often necessary in these patients, as osteoarthritis is an early manifestation of the disease. However, only a few cases of periprosthetic fractures have been reported in the literature. A 73-year-old female patient sustained a periprosthetic fracture of the right femur after a fall from standing height. The patient had undergone a total hip arthroplasty surgery 10 years ago. Intraoperatively both the acetabular cup and the femoral stem were found stable, thus the fracture was treated using plating with locking screws and cables. No postoperative complication was observed and the fracture was completely healed after 6 months. Periprosthetic fracture management poses special difficulties and technical issues in patients with osteopetrosis. Hematologist consultation is an important part of the preoperative preparation, while a careful postoperative follow-up is crucial due to the high rates of postoperative complications. The intraoperative technical challenges in the management of an osteopetrotic bone are many due to the abnormal bone density. Orthopedic surgeons have to engage specific strategies to avoid pitfalls as interventions are technically challenging, leading to prolonged operative time and increased blood loss.