Bipolar Hemiarthroplasty of Hip in an Unstable Angina Patient: A Case Report

Fracture neck of femur is a leading cause of hospital admission in elderly population. Studies have shown up to 25% mortality following hip fracture within 1year of surgery [1]. We report a case of fracture neck of femur in a high-risk patient with end-stage renal disease who was operated with bipolar hemiarthroplasty. We noticed favorable outcome following coronary artery bypass graft (CABG) and orthopedic surgery.

We report a case of 72-year-old male presenting with the right hip pain for 2 days and inability to bear weight on the right lower limb following history of domestic fall 2 days back. Radiograph of pelvis with both hips anteroposterior view and lateral view of the right hip showed right fracture neck of femur. The patient was scheduled for surgery next day but was deemed unfit on the ground of electrocardiogram reports showing ventricular arrhythmia. Cardiologist opinion was sought and coronary angiography was done. Coronary angiography revealed triple vessel lumen blockade. The patient underwent CABG 2 weeks after admission. We did cement bipolar hemiarthroplasty for the right fracture neck of femur 1 week later. The patient was mobilized on day 2 using walker. Follow-up radiograph showed acceptable prosthesis position.

Fracture neck of femur with associated cardiac risk and end-stage renal disease require meticulous planning before surgical intervention. Our case highlights the need of stabilizing medical and cardiac parameters before orthopedic intervention. One of the absolute contraindications for surgery in fracture neck of femur is unstable angina. Stabilization of unstable angina is necessary and demands priority over surgery for fracture neck of femur. Although there is time delay due to unstable angina and other medical conditions with fracture neck of femur, there is a need for further evaluation in such patients to get favorable outcome.