Intraoperative Management of a Distal Femoral Neck Cut Complicated by Greater Trochanter Avulsion During Total Hip Arthroplasty With High Offset Stem and Cement Fixation.

Total hip replacement (THR) is a common orthopedic surgery performed to relieve pain and restore mobility in patients with severe hip arthritis. While most surgeries proceed without major issues, rare complications during the operation can make the procedure more challenging and potentially affect recovery. We present the case of a 77-year-old man who underwent a right THR through the anterior surgical approach to treat advanced osteoarthritis. During surgery, two unexpected problems occurred: the cut made to remove the damaged femoral head was placed too far down the bone, and a portion of the upper thigh bone called the greater trochanter, where important muscles attach, became detached. Before surgery, detailed planning was done using CT-based Mako robotic navigation, which helped choose the most suitable implant and determine the correct positioning. During the procedure, a high-offset cemented femoral stem was selected to restore the patient's natural hip mechanics. The detached greater trochanter was repaired using strong sutures passed through holes in the bone (transosseous fixation). After surgery, the patient was kept off the operated leg initially to protect the repair. He gradually progressed to partial weight-bearing by three months, and follow-up imaging showed excellent healing and implant position. Functionally, he returned to daily activities without pain. This case underscores the importance of adaptability during surgery, even with advanced planning. It also highlights how robotic planning, specialized implant selection, and careful repair of soft tissue attachments can be successfully combined to address unexpected challenges and achieve an excellent outcome.