Distally fixed stem reconstruction for extensive femoral osteonecrosis involving the greater trochanter

Osteonecrosis of the femoral head is typically limited to the femoral head; extension to the greater trochanter is exceedingly rare and poses challenges for femoral stem selection. We describe the case of a 61-year-old man with right hip pain, a history of corticosteroid therapy, and habitual alcohol consumption - both established risk factors for osteonecrosis. Radiographs showed femoral head collapse, and contrast-enhanced magnetic resonance imaging revealed poor enhancement extending to the greater trochanter. The patient underwent total hip arthroplasty with a Wagner SL revision stem. Histological analysis confirmed necrosis in the femoral head and greater trochanter. At 10 months, the patient demonstrated stable radiographic fixation and favourable short-term recovery. This rare presentation of osteonecrosis extending to the greater trochanter highlights the value of a distally fixed stem in achieving stable fixation.