Partial Femoral Diaphysectomy With Vastus Lateralis Interposition in a Paraplegic Patient With Severely Debilitating Hip Ankylosis: Low Risks and High Gains?

We present the case of a 56-year-old male unable to sit because of an ankylosed right hip. This ankylosis originated from combined neurogenic heterotopic ossifications (NHO) and traumatic heterotopic ossifications (THO) as a result of a road traffic accident. Because of multiple ossifications, the proximity of neurovascular structures, and chronic pressure ulcers, a resection was deemed unsafe. We opted for a new articulation distal to the ossifications in unstained tissue. A partial femoral diaphysectomy was performed just distal of the lesser trochanter. and the vastus lateralis was rotated in the new articulation. Postoperatively, the patient was able to sit as his hip could flex again. A partial femoral diaphysectomy with vastus lateralis interposition flap appears to be a valid option in paraplegic patients with extensive heterotopic ossifications (HO) in close proximity to neurovascular structures with a low risk of complications and high gain in hip mobility.

Automated summary

We report a case of a 56-year-old male with an ankylosed right hip due to combined neurogenic and traumatic heterotopic ossifications. Due to the complexity of multiple ossifications, proximity to important structures, and chronic ulcers, resection was considered unsafe. A new articulation was created distal to the ossifications by performing a partial femoral diaphysectomy and rotating the vastus lateralis muscle. Postoperatively, the patient regained hip mobility and was able to sit. This procedure appears to be a feasible option for paraplegic patients with extensive heterotopic ossifications in close proximity to neurovascular structures.