# Challenges of Hip Arthroplasty in a Paretic, Spastic Limb: A Case Study on Managing Femoral Neck Fracture Following Fixation Failure in a Hemiparetic Patient

## TL;DR

This case study explores the challenges of hip replacement surgery in a patient with spastic hemiparesis and highlights the importance of preoperative rehabilitation.

## Contribution

The study introduces a multidisciplinary approach combining botulinum toxin injections and physiotherapy for spastic patients undergoing hip arthroplasty.

## Key findings

- Preoperative botulinum toxin injections and physiotherapy improved limb function in a spastic patient.
- Comprehensive rehabilitation is essential for successful hip arthroplasty in patients with spastic paralysis.
- Standardized treatment protocols are needed for managing hip fractures in spastic patients.

## Abstract

Background: Hip fractures and strokes are prevalent and escalating issues in geriatric healthcare. The absence of standardized surgical protocols for patients with spastic hemiparesis and multiple comorbidities presents a significant medical challenge. Methods: This case study describes a 64-year-old male patient with left-sided hemiparesis and failed surgical treatment of a pertrochanteric fracture in a spastic limb. The patient was admitted to the Department of Rehabilitation and Orthopedics in December 2022 for diagnostics and to establish a treatment plan after five months of non-ambulatory status. Results: This study emphasizes the crucial role of preoperative preparation, involving botulinum toxin injections into spastic muscles and physiotherapy, to enhance the supportive function of the paretic limb and improve locomotion before prosthetic surgery. Conclusions: The management of hip fractures in patients with spastic paralysis requires a multidisciplinary approach and the development of standardized treatment protocols. This case underscores the importance of comprehensive pre- and postoperative rehabilitation to improve patient outcomes. Further research is needed to establish standardized rehabilitation protocols for spastic patients undergoing hip arthroplasty. Randomized controlled trials could provide valuable insights into the efficacy of various interventions.