Document Type : Case Report


Ortopedia-traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy



Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications.
Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later.
Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications.
Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases.


  1. Barquet A, Giannoudis PV, Gelink A. Femoral neck fractures after removal of hardware in healed trochanteric fractures. Injury. 2017;48(12):2619-2624. doi:10.1016/j.injury.2017.11.031.
  2. Sassoon AA, Trousdale RT. Technical considerations in total hip arthroplasty after femoral and periacetabular osteotomies. Orthop Clin North Am. 2012;43(3):387-393. doi:10.1016/j.ocl.2012.05.006.
  3. Ferguson GM, Cabanela ME, Ilstrup DM. Total hip arthroplasty after failed intertrochanteric osteotomy. J Bone Joint Surg Br. 1994;76(2):252-257. doi:10.1302/0301-620X.76B2.8113286.
  4. Pui CM, Bostrom MP, Westrich GH, et al. Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures: a multi-center study. J Arthroplasty. 2013;28(8 Suppl):45-47. doi:10.1016/j.arth.2013.04.048.
  5. Boos N, Krushell R, Ganz R, Muller ME. Total hip arthroplasty after previous proximal femoral osteotomy. J Bone Joint Surg Br. 1997;79(2):247-253. doi:10.1302/0301-620X.79B2.0790247.
  6. Yuasa T, Maezawa K, Taniguchi Y, Aritomi K, Kaneko K. Atypical Subtrochanteric Femoral Fracture Below an Arthritic Hip: A Case Report. JBJS Case Connect. 2015;5(1):e1-e6. doi:10.2106/JBJS.CC.N.00030.
  7. Oztürkmen Y, Uzümcügil O, Sükür E, Karamehmetoğlu M, Caniklioğlu M. The use of a cementless modular stem in the treatment of subtrochanteric femoral fractures in conjunction with ipsilateral coxarthrosis. Orthopedics. 2011;34(1):13. doi:10.3928/01477447-20101123-12.
  8. Enocson A, Mattisson L, Ottosson C, Lapidus LJ. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop. 2012;83(5):493-498. doi:10.3109/17453674.2012.688724.
  9. Weiss RJ, Karrholm J, Hailer NP, Beckman MO, Stark A. Salvage of failed trochanteric and subtrochanteric fractures using a distally fixed, modular, uncemented hip revision stem. Acta Orthop. 2012;83(5):488-492. doi:10.3109/17453674.2012.733917.
  10. Thakur RR, Deshmukh AJ, Goyal A, Ranawat AS, Rasquinha VJ, Rodriguez JA. Management of failed trochanteric fracture fixation with cementless modular hip arthroplasty using a distally fixing stem. J Arthroplasty. 2011;26(3):398-403. doi: 10.1016/j.arth.2010.01.103.