Proximal Femoral Replacement for Infected Non-union of the Proximal Femur With Adherent Femoral Artery: Surgical Challenges and Techniques to Minimize Vascular Risk

Chronic infection and non-union of the proximal femur pose significant reconstruction challenges, where repeated surgical interventions can lead to bone loss and vascular adherence. The attachment of the profunda femoral artery (PFA) adds a substantial risk of intra-operative bleeding. We report a case of a 72-year-old female patient with ongoing pain and severe functional limitation after failed fixation complicated by chronic infection and subsequent excision arthroplasty. She underwent a proximal femur replacement (PFR) using a DePuy Synthes modular system with a constrained acetabular liner. Before the operation, infection control was achieved, and vascular mapping was done via CT angiogram, which suggested tethering of the PFA to the medial femoral cortex. Sharp dissection, vascular isolation with loops, and Doppler monitoring were all part of the intra-operative strategy used. This case report demonstrates that PFR can be an effective limb salvage option in the context of chronic infection and non-union of a proximal femoral fracture, and how operational success depends on careful pre-operative planning and precise surgical execution.