Seizure-Induced Periprosthetic Femoral Fracture After Total Hip Arthroplasty in a Patient With Epilepsy: A Case Report

TL;DR

A 27-year-old man with epilepsy experienced a hip fracture after a seizure due to noncompliance with his anti-epileptic medication.

Contribution

This case report documents a rare periprosthetic femoral fracture after total hip arthroplasty caused by seizure activity.

Findings

Nonadherence to anti-epileptic medications increases the risk of seizure recurrence and subsequent skeletal trauma.

The patient had a Vancouver B2 periprosthetic fracture with femoral stem subsidence following a seizure.

The case emphasizes the importance of medication adherence and bone health monitoring in patients with epilepsy.

Abstract

Fractures secondary to seizure activity are a well-known complication in patients with epilepsy; however, periprosthetic fractures following total hip arthroplasty (THA) due to seizures are rarely documented. Nonadherence to anti-epileptic medications (AEMs) significantly increases the risk of seizure recurrence, particularly in individuals with a history of seizure-induced skeletal trauma. We present the case of a 27-year-old male with a documented history of epilepsy who sustained a right periprosthetic femoral fracture following a generalized tonic-clonic seizure. One year prior, the patient had undergone THA due to post-traumatic acetabular arthritis, which developed after a seizure-induced acetabular fracture. He later became noncompliant with his prescribed levetiracetam regimen, discontinuing use approximately one month after his initial THA. Imaging revealed a Vancouver B2 periprosthetic fracture with femoral stem subsidence. The patient underwent revision THA with open reduction and internal fixation and had an uneventful postoperative course. This case highlights the critical importance of medication adherence in patients with epilepsy, especially those with prior seizure-related orthopedic injuries. It also raises the need for further research into the long-term effects of levetiracetam on bone health. Regardless of the specific AEM, physicians should maintain a high index of suspicion for bone health deterioration and consider routine bone mineral density screening in this unique patient population.

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