Bilateral femoral neck stress fractures following total knee arthroplasty: a case report and review of literature

Stress fracture of the femoral neck following total knee arthroplasty (TKA) is an uncommon complication with only 20 cases having been described in English literature so far. Stress fractures of femoral neck occurring simultaneously on both sides following a bilateral total knee replacement is an exceptional occurrence, which to the best of our knowledge, has not been described previously. We describe a patient suffering from osteoarthritis of both knees, who was treated with bilateral total knee arthroplasty simultaneously. He developed spontaneous fractures of femoral neck on both sides 9 months following the total knee replacement in the absence of any known risk factors for stress fractures. He was treated with bipolar hemi replacement arthroplasty for displaced fracture on one side and closed reduction/internal fixation on the undisplaced side. A high index of suspicion is needed to diagnose this unusual complication of total knee arthroplasty before the fracture displaces necessitating a prosthetic replacement.