Total Hip Arthroplasty After Femoral Neck Fracture in an Ipsilateral High Transfemoral Amputee With Less Than 50% Femoral Length.

Total hip arthroplasty (THA) in ipsilateral transfemoral amputees is rare and technically demanding; literature seldom quantifies stump length. We report a 69-year-old male with ipsilateral high transfemoral amputation (<50% femoral length) who sustained a displaced subcapital femoral neck fracture and underwent primary THA. The residual femoral stump measured approximately 215 mm (46.7% of contralateral femoral length) on preoperative CT-based templating. Perioperative management addressed positioning, manipulation of the short limb, and component alignment. At eight months, the patient ambulated with a prosthesis and crutches at the pre-injury functional level, reported no hip pain or instability, and radiographs confirmed stable fixation. This case adds a quantified example of high transfemoral amputation with documented mid-term recovery and practical recommendations for exposure, manipulation, and component version planning. Quantifying stump length and tailoring intraoperative technique are key to safe THA in high transfemoral amputees; favorable outcomes can be achieved with individualized planning.