Periprosthetic Fractures and Acetabular Loosening after Surgical Treatment of Bilateral Femoral Neck Pathological Fractures Secondary to Hypocalcemic Seizure with Chronic Renal Failure：A Case Report and Review of the Literature

Abstract

Background: Long-term hemodialysis treatment of chronic kidney disease (CKD) can lead to disorder of calcium and phosphorus regulation and abnormal parathyroid function. Most patients with renal failure often have secondary hyperparathyroidism, at which time the parathyroid glands can release large amounts of parathyroid hormone (PTH), which activate osteoclast activity to increase serum calcium levels, resulting in severe skeletal diseases, including osteoporosis, pathological fractures, bone pain. Case presentation: We report a case of a 62-year-old woman with bilateral femoral neck pathological fractures who was diagnosed with tertiary hyperparathyroidism and severe osteoporosis due to long-term hemodialysis treatment for renal failure. On the 1st day after bilateral total hip arthroplasty (THA), sudden seizure resulted in periprosthetic fractures and acetabular loosening. After the patient’s condition stabilized, bilateral revision total hip arthroplasty was performed respectively. There are no similar reports in the previous literature. Conclusions: Perioperative anti-osteoporotic therapy and close monitoring of serum calcium levels are beneficial in long-term hemodialysis patients with hip fractures. At the same time, more attention should be paid to refractures caused by severe osteoporosis and hypocalcemic seizure after THA.