Total Hip Replacement in Adults with Neglected Femoral Neck Fractures Through Posterior Approach: A Case Report

Introduction: Osteoarthritis (OA) is the degenerative joint disease. The most common symptom is knee pain that gradually develops and gets worse with movement. The presence of OA may increase the likelihood of falls, an independent risk factor for hip fracture Femoral neck fractures in the elderly are linked to low-energy falls which correlated with OA as the comorbidity. Hip fracture risk is doubled in patients with a clinical diagnosis of knee OA. Given the poor prognosis and inconsistent results recorded following various surgeries, femoral neck fracture is still regarded as an unresolved fracture. The two main side effects of femoral neck fractures are avascular necrosis of the femoral head and nonunion or neglected fracture. The risk of femoral head avascular necrosis has led to the widespread use of arthroplasty in older individuals. There are two varieties, including total hip arthroplasty and hemiarthroplasty. Case Presentation: A 74 years old female patient complained knee pain on both side in the last three years, and worsen at the past 6 months, she felt the pain worse on the left knee. The patient was diagnosed with neglected displaced left femoral neck fracture and bilateral knee osteoarthritis (OA). The patient was treated with total hip arthroplasty (THA) through posterior approach. Discussion: THA is recommended for patients with symptomatic pre-injury OA because untreated pre-existing OA that was restricting the patient's mobility before the injury could have an adverse effect on their ability to recover after hip fracture surgery. Post-surgery, the patient’s clinical condition was good with no other symptoms except mild pain. Conclusion: Femoral neck fractures commonly occur in elderly women. Pre-existing osteoarthritis reduces mobility, increases the patient’s likelihood to experience femoral neck fracture. Total Hemiarthroplasty (THA) is a better choice for better long-term outcomes. Posterior approach seems to be a better option than direct anterior approach. Keywords: femoral neck fracture, osteoarthritis, elderly women, total hip arthroplasty, posterior approach