Hong Kong Med J 2011;17:495-9 | Number 6, December 2011
Disseminated amyloidosis presenting with right proximal femur pathological fracture in a haemodialysis end-stage renal failure patient
Alexander PH Chan, Tom CY Cheung, SY Cheung, Eric PY Ho, Jason CH Fan, K Wang, KY Fung
Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
Osteoarticular amyloidosis can be one of the musculoskeletal system manifestations related to dialysis. We share our experience in dealing with a case of disseminated haemodialysis-associated amyloidosis in a 74-year-old end-stage renal failure patient. This patient suffered from a serious complication, namely an unprovoked pathological fracture at the basal neck region of the right femur. Polyarticular cystic and lytic lesions over the contralateral proximal femur, bilateral proximal humerus and the right lunate were noted on further imaging. In view of extensive amyloidotic infiltration into the proximal femur as well as the acetabulum, a cemented total hip arthroplasty operation was performed for pain relief and restoration of function. The radiological investigations, diagnostic challenges, operative as well as histopathological findings are discussed. This disease should be considered in the differential diagnosis of pathological juxta-articular fracture in patients undergoing haemodialysis.
Key words: Arthroplasty, replacement; Amyloidosis; Hip fractures; Kidney failure, chronic; Renal dialysis
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