Total Hip Replacement in a Patient with Bilateral Infrapatellar Amputation: Case Report, Literature Review, Tips and Tricks

Patients with lower limb amputation (LLA) are prone to greater physical demands. Retrospective studies reported 5 to 61% of ipsilateral or contralateral hip osteoarthritis after LLA. Total hip arthroplasty (THA) has proven effective in improving the quality of life of patients with hip osteoarthritis. Its incidence after ipsilateral LLA is reported to be 0.067%. There is little information on the technical aspects and results of this procedure in such patients. The objective of this study is to report a patient with bilateral LLA and ipsilateral hip arthritis treated with THA, highlighting the challenges of the surgical technique and the postoperative protocol. After Internal Review Board approval (IRB00010193), we present a 64-year-old male patient with bilateral infrapatellar amputation who underwent left THA where the surgical challenge lies in being able to perform an adequate osteotomy of the femoral neck, obtaining an adequate exposure of the femoral canal, and achieving a correct implant placement. Wide release of the psoas and gluteus maximus tendons was necessary to ease femoral preparation and intraoperative maneuverability of the lower extremity. Although THA is a common procedure, when performed in an unusual patient and in the absence of therapeutic guidelines or consensus when dealing with this association, an appropriate preoperative plan should be followed. This case provides a perioperative approach focused on the search for possible intraoperative scenarios that may occur in patients who will undergo a THA after LLA.