Zeitschrift für Wirbelsäule

Progression of Hip Joint Deformity during the Management of Pelvic Insufficiency Fracture in a Patient with Rheumatoid Arthritis: A Case Report

Abstract

Kenji Ikuta, Yuko Waguri-Nagaya, Masahiro Nozaki, Jun Mizutani, Hideyuki Goto, Masaaki Kobayashi and Takanobu Otsuka

Introduction: An insufficiency fracture is a type of non-traumatic fracture caused by bone fragility that most commonly occurs in the pelvis and lower extremities. Although sacral insufficiency fracture is not uncommon, its diagnosis is often delayed or missed. We here report the case of SIF with rheumatoid arthritis that occurred during the pre-operative waiting time for total hip arthroplasty.

Case presentation: A 57-year-old woman with rheumatoid arthritis presented with sacral insufficiency fracture that occurred during the pre-operative waiting time for total hip arthroplasty. During the four months after the onset of the sacral insufficiency fracture, her pubis, ischium and acetabulum fractured and deformity of her left hip joint gradually progressed. Total hip arthroplasty was performed using bone grafting onto the acetabulum from the autogenous femoral head. The findings upon clinical examination and the patient’s assessment of function were excellent at the time of the most recent follow-up.

Conclusion: When total hip arthoplasty is performed in patients with severe osteoporosis or insufficiency fracture of the acetabulum, it is essential to avoid additional pelvic factures at the time of setting the acetabular cup component. Moreover, as a total hip arthoplasty might itself be a predisposing causative factor of pelvic insufficiency fracture, recurrence of insufficiency fractures should be monitored in those patients with the history. Aggressive intervention for osteoporosis might be necessary to prevent insufficiency fracture development.