Total Hip Arthroplasty After Prior Surgical Treatment of Hip Fracture Is it Always Challenging?
ABSTRACT Salvage total hip arthroplasty (THA) presents a viable solution for failed open reduction internal fixation. This study compares salvage THA in patients with prior femoral neck fractures vs patients with prior intertrochanteric fractures. One hundred fifty-four hips in 152 patients underwent conversion from open reduction internal fixation to THA. Eighty-three patients had previous femoral neck fractures, and 69 patients (71 hips) had prior intertrochanteric fractures. Salvage THA in patients with prior intertrochanteric fractures presented a more technically demanding procedure with longer operative times and larger amounts of blood loss. Although conversion THA presents a technically challenging procedure, it is safe and yields relatively few orthopedic complications.
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ABSTRACT: This cadaveric study was designed to clarify the anatomic basis of using an anterolateral intermuscular approach to repair type A2 intertrochanteric fractures (ITF). The conventional lateral approach to surgery that is used for ITF has several disadvantages that can result in both intraoperative and postoperative complications, especially for type A2 ITF. Previous studies have suggested using minimally-invasive total hip arthroplasty (THA) with an anterolateral approach. The legs of 10 formalin-fixed Asian cadavers were dissected, simulating an anterolateral surgical approach. The distances from the superior gluteal nerve and the lateral femoral circumflex artery branches to the lateral protrusive point of the greater trochanter were measured. The anterolateral intermuscular approach provided excellent exposure of the GT, the lesser trochanter and the femoral neck. The gluteus medius branch of the ascending branch of the lateral femoral circumflex artery (GMB-LFCA) and the most inferior branch of the superior gluteal nerve (MIB-SGN) were found to cross the spatium intermusculare between the gluteus medius and the tensor fasciae latae. The distance from the GMB-LFCA, in the intermuscular plane, to the lateral protrusive point of the GT was (4.04 ± 1.00 cm, range 2.96-6.62 cm); and the distance from the MIB-SGN to the lateral protrusive point of the GT was (5.47 ± 1.61 cm, range 3.68-9.56 cm). The anterolateral intermuscular approach is relatively safe, provides excellent exposure, and causes less soft-tissue damage than the traditional approach, and it represents a promising new method to surgically treat type A2 ITF.International surgery 02/2015; 100(2):314-9. DOI:10.9738/INTSURG-D-14-00188.1 · 0.25 Impact Factor
Article: The Standard Black
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ABSTRACT: Background and aims Hip arthroplasty has been advocated as a salvage procedure after failed nailing of proximal femoral fractures. The aim of the current study was to evaluate chirurgical complications of hip arthroplasty after failed nailing of proximal femoral fractures. The second aim was to compare the complication profile of semiendoprosthesis (SEP) to that of total endoprosthesis (TEP). Materials and methods There were 1,533 Gamma- or DHS-nailed proximal femoral fractures altogether at our institution during the study period 2000–2010. We reviewed the medical records of 51 hips in 50 patients with failed nailing of fracture followed by hip arthroplasty (3.3 % of all nailed proximal femoral fractures). The patients were identified retrospectively from a single academic institution’s computerized database. Results There was at least one re-operation after arthroplasty in ten patients (20 %). Dislocation was the most common reason of the re-operation (six patients). The SEP and TEP groups did not differ significantly from each other with regard the re-operation rate (p = 0.72). Conclusions Failed arthroplasty is common after failed nailing of proximal femoral fractures.12/2012; 3(4). DOI:10.1007/s12570-012-0133-7