Preprosthesis fracture of femoral and loosening of the femoral prosthesis during closed reduction of hip dislocation: A case report

INTRODUCTION: Dislocation after bipolar hip hemiarthroplasty is an uncommon complication. Although closed manoeuvre reduction under general anaesthesia is a common and effective method for dislocation of the hemiarthroplasty. However, closed reduction leads to preprosthesis fracture of femoral and loosening of femoral prosthesis is a rare situation, which requires incision reduction and a revision hemiarthroplasty. PRESENTATION OF CASE: A 80-year-old female had cementless bipolar hip hemiarthroplasty due to a right femoral neck fracture. At the 11 days of postoperation, the patient had a dislocation of the hemiarthroplasty when squatting. The patient had preprosthesis fracture and loosening of the prosthesis during closed reduction. Eventually, the patient had an open reduction and femoral stem revision. There was no re-dislocation and no re-fracture at one-year follow-up. DISCUSSION: Closed manoeuvre reduction is a common and effective method for dislocation of the hemiarthroplasty. But if not done properly, it may lead to preprosthesis fracture of femoral and loosening of the femoral prosthesis. Preprosthesis fracture of femoral and loosening of femoral prosthesis is a complex complication. This condition requires operative treatment. A personalized surgical plan and proper techniques should be done before the operation. CONCLUSION: Closed reduction should be performed gently to avoid preprosthesis fracture and loosening of the prosthesis. If this happens, a high-resolution CT examination should be performed immediately to evaluate the fracture and the rotation of the prosthesis. In the case of dislocation after bipolar hip hemiarthroplasty in patients with Alzheimer's disease, we hypothesize that early wearing braces to limit squat might help prevent this condition.