A Catastrophic Cascade of Postoperative Complications Following Hemiarthroplasty for Femoral Neck Fracture in a Middle-Aged Patient With Schizophrenia

Abstract

The treatment of a patient with schizophrenia suffering a subcapital hip fracture may be challenging, mainly due to the high risk of postoperative medical and surgical complications. Mechanical complications from the implant are also frequently encountered following hip arthroplasty in patients with schizophrenia. We report the case of a 57-year-old male patient with schizophrenia who underwent hip hemiarthroplasty for a displaced femoral neck fracture. During the initial postoperative period, the patient developed a cascade of surgical and mechanical complications, leading to multiple revision procedures and a suboptimal outcome. The ideal type of treatment of patients with schizophrenia with subcapital hip fracture is still missing. It is, therefore, important to highlight the high risk of postoperative complications in patients with schizophrenia who present with subcapital fractures subsequently treated with hemiarthroplasty.

Case Report: Management strategy of rare case first-generation antipsychotic drug induced neglected femoral neck fracture in schizophrenia patients

“…7 The only effective treatment for a desired hip fracture is surgery. 8 However, the course of treatment is determined by the patient's age, the severity of any pre-traumatic symptoms, the type of fracture, and its dislocation. 9 Compared to second-generation antipsychotics, first-generation antipsychotics (AGPs) seem to have a higher risk of fracture (AGKs).…”

“…15,16 Hemi hip arthroplasty is indicated when there is no acetabular dysplasia and complete hip arthroplasty is preferred when there is acetabular dysplasia. 8 Since there was still no acetabular dysplasia, the patient in this case study was finally treated with a hemi hip arthroplasty. However, three months post-surgery X-ray shows the acetabulum dysplasia and lytic lesion, so we suggest performing total hip arthroplasty (THA) with or without acetabular dysplasia to prevent repeated surgery.…”

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

“…Frail and low-demand patients with high-risk of dislocation due to abductor insufficiency or neuromuscular deficit may be the ideal recipients of CLs in THA. 23 Unfortunately, no clinical frailty scale was used to evaluate the frailty, but this may be assessed by a future study.…”

“…Frail and low-demand patients with high-risk of dislocation due to abductor insufficiency or neuromuscular deficit may be the ideal recipients of CLs in THA. 23 Unfortunately, no clinical frailty scale was used to evaluate the frailty, but this may be assessed by a future study. The restricted hip motion increases the risk of neck impingement, producing excessive torque forces at the locking ring or the outer polyethylene-metal shell interface, thereby increasing polyethylene wear and risk of osteolysis.…”