Conversion Total Hip Arthroplasty Following Failed Hip Fracture Fixation in a Patient with Factor XI Deficiency: A Case Report

Introduction: Factor XI (FXI) deficiency is a hematologic condition that is rarely encountered by the arthroplasty surgeon. Effective risk assessment and perioperative management are paramount in minimizing the risk of intra- and post-operative bleeding in this patient population. An interdisciplinary approach is crucial in minimizing complications and achieving successful outcomes. We present the case of a patient that successfully underwent conversion total hip arthroplasty (THA) following failed internal fixation of a proximal femur fracture.

Case report: A 71-year-old man with a history of FXI deficiency presented with significant right-sided hip pain secondary to post-traumatic arthritis from a previously treated right proximal femur fracture. The patient underwent removal of the cephalomedullary nail and conversion to a THA. Before the procedure, a comprehensive perioperative plan was enacted to manage the patient's FXI deficiency. The patient underwent several infusions of aminocaproic acid and tranexamic acid (TXA) in an effort to prevent intra- and post-operative bleeding. The surgery was completed with excellent hemostasis and no post-operative complications.

Conclusion: Patients with FXI deficiency can successfully undergo conversion THA surgery; however, an individualized hematologic plan must be enacted to minimize complications and maximize surgical outcomes and patient satisfaction. This case demonstrates that the antifibrinolytic agents, aminocaproic acid and TXA, can be successfully used for hematologic prophylaxis in the perioperative period for this population of patients.