Staged Surgical Management of Complex Periprosthetic Fractures in a Young Patient Following Total Hip Arthroplasty: A Case Report and Treatment Strategy Analysis

Introduction: Periprosthetic fractures following THA represent a significant clinical complication, with combined fractures involving both femoral and acetabular components being particularly rare in younger patient populations. The management of such complex cases presents multiple clinical challenges, including intricate surgical decision-making and postoperative rehabilitation considerations. This article presents a comprehensive case report detailing the staged treatment protocol for a young patient with combined periprosthetic fractures, while critically analyzing the diagnostic challenges, therapeutic complexities, and potential strategies for treatment optimization. Case presentation :This case report describes a 36-year-old male patient with a history of left THA performed for femoral head avascular necrosis. The patient sustained a high-energy trauma to the left hip during a traffic accident while intoxicated, resulting in multiple injuries including hemorrhagic shock, combined periprosthetic fractures (acetabular AO 62-A32 and femoral Vancouver type B2), and associated soft tissue damage. The patient underwent a two-stage surgical management protocol: initial stabilization of the acetabular fracture followed by subsequent femoral prosthesis revision. A structured, phased rehabilitation program was implemented postoperatively. At the 12-month follow-up, radiographic evaluation demonstrated satisfactory fracture union, with functional assessment yielding a modified Harris Hip Score of 80 points, indicating favorable clinical outcomes. Conclusion: The management of such complex fractures necessitates the formulation of individualized treatment strategies, incorporating multiple clinical and biomechanical considerations. In the present case, the intricate interplay between fracture displacement patterns and prosthesis stability significantly increased the surgical complexity. The implementation of staged surgical intervention adhered to the principles of Damage Control Orthopedics (DCO), with an appropriately designed combination of prosthetic revision and internal fixation. Nevertheless, the procedure presented several technical challenges, including precise screw placement, articular surface reconstruction, and femoral component revision. Future advancements in surgical navigation, patient-specific instrumentation, and biomaterial technology may further enhance treatment outcomes. This case report aims to provide valuable insights and serve as a reference for the management of similar complex periprosthetic fractures.