Primary Hemiarthroplasty for Management of Femoral Neck Fracture in a Patient with Ipsilateral Below-Knee Amputation: A Case Report with Review of Literature

Introduction: Femoral neck fractures in lower limb amputees are uncommon. Technical difficulties include patient positioning, stump manipulation, and poor bone quality due to osteoporosis. We report the case of a 55-year-old woman with a femoral neck fracture and an ipsilateral below-knee amputation (BKA), managed with hemiarthroplasty. Case Report: The patient was diagnosed with a femoral neck fracture on the right side after she had a fall at home. She had undergone BKA due to complications of a diabetic foot 9 months earlier. We performed uncemented hemiarthroplasty with an Austin-Moore prosthesis using the posterior approach. No special devices or maneuvers were required for the manipulation of the stump during surgery. The post-operative period was uneventful, and the patient began weight-bearing with a walker and prosthetic limb about 10 days after surgery. Throughout the 25-month follow-up period, no clinical or radiological complications related to the hemiarthroplasty were identified, and her final Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) score improved to 80.55. The patient succumbed to breast cancer 1 month following the most recent follow-up. Conclusion: Hemiarthroplasty remains a reliable option for managing femoral neck fractures in below-knee amputees. However, difficulties in limb manipulation must be anticipated. Gentle handling and meticulous surgical technique are critical in avoiding iatrogenic complications. Keywords: Hemiarthroplasty, Austin-Moore prosthesis, below-knee amputee, lower limb amputee, femoral neck fracture, femur neck fracture.