title: A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed 22 years earlier: a case report.
abstract: BACKGROUND
  Treatment of femoral neck fractures in young adults may require total hip arthroplasty or hip hemiarthroplasty using a bipolar cup. The latter can, however, result in migration of the femoral head and poor long-term results.
  
  
  METHODS
  We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof. After bone union of the femoral shaft fracture, the patient was referred to our hospital for reconstruction of the acetabular roof. Intra-operatively, we placed two alloimplants of bone from around the transplanted femoral head into the weight-bearing region of the acetabular roof using an impaction bone graft method. We then implanted an acetabular roof reinforcement plate and a cemented polyethylene cup in the position of the original acetabular cup. Eighteen months post-operatively, X-rays showed union of the transplanted bone.
  
  
  CONCLUSIONS
  Treatment of femoral neck fractures in young adults is usually accomplished by osteosynthesis, but it may be complicated by femoral head avascular necrosis or by infection or osteomyelitis. In such cases, once an infection has subsided, either hip hemiarthroplasty using a bipolar cup or total hip arthroplasty may be required. However, if the acetabular side articular cartilage is damaged, a bipolar cup should not be used. Total hip arthroplasty should be performed to prevent migration of the implant.
authors.affiliation: Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Izunagaoka 1129, Izunokuni-country 410-2295, Shizuoka, Japan. tetsutakan@aol.com.
authors.forename: Akio
authors.initials: A
authors.lastname: Kanda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kaneko
authors.forename: Osamu
authors.initials: O
authors.lastname: Obayashi
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Mogami
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D062785:Hemiarthroplasty / Q000009:adverse effects*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D016474:Weight-Bearing