Acute femoral neck fractures after resurfacing total hip arthroplasties
have been reported in the literature. Only few papers considered non
operative treatment for periprosthetic fracture after Birminghan hip
procedure1. Of 134 consecutive hip resurfacing procedures between
April 2002 and December 2007 we report three cases of non
displaced femoral neck fractures. All three were men suffering from
osteoarthritis. The first 62 yo patient developed pain progressively
4 months after the hip resurfacing without any trauma. He was totally
pain free one month following the procedure. Standard Xrays were
unremarkable. Scintigraphic exam showed hyperactivity around the
neck and blood tests showed a slight elevated CRP. At the revision
performed at 6 months we observed a fracture just beneath the head
of the prosthesis. The morphological analysis confirmed a stress
fracture. The second case occurred in a 43 yo active man. He reported
persistent hip pain during the first 4 months. At the 6 month check the
standard Xrays showed a dense horizontal line 3 millimeters distal to
the femoral head component. Retrospectively, we consider that line as
the result of a healed stress fracture of the femoral neck considering
the history of the patient. He is now pain free. The third case occurred
in an extremely active 55 yo man who did not respect our
postoperative reeducation procedures. Two weeks after the operation,
he tried to run without crutches. Since that time and for 6 months he
sustained hip pain that disappeared rapidly after the seventh month.
We did not observe any fracture or component loosening on the Xrays
taken at the 1st, 2nd or 4th month. At six months, we discovered a
dense line on X ray at the same position as for the preceding case.
We consider once again a femoral neck stress fracture.
Conclusion: Even if femoral neck stress fracture is a rare
complication after total hip resurfacing procedure, it should be
considered for diagnosis and can be treated conservatively.