Total hip arthroplasty after prior surgical treatment of hip fracture is it always challenging?

Rothman Institute of Orthopedics at Thomas Jefferson University,Philadelphia, Pennsylvania 19107, USA.
The Journal of arthroplasty (Impact Factor: 2.37). 07/2011; 27(1):31-6. DOI: 10.1016/j.arth.2011.05.014
Source: PubMed

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: A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head. Non-surgical management with partial weight bearing can only be selected for early stages and very small lesions. Even in such cases, it has been proven to be ineffective in 80-90 % of patients. Conversely, the results with trabecular metal implants are not always clinically satisfactory, and some patients can show emerging pain and activity limitations that could require conversion to a total hip arthroplasty. Hereby we report the results of 6 patients who underwent this implant and describe the histopathology of the bone at the femoral neck and to speculate on the causes of complications encountered during arthroplasty surgery. The necrosis was stopped in 1 case, and 5 hips showed disease progression. Two protrusions of the screw apex were observed. In one case, rupture of the greater trochanter during prosthesis implant occurred. After trabecular metal implants for avascular osteonecrosis, some patients can require conversion to a total hip arthroplasty. Two patients had an intraoperative fracture with detachment of the greater trochanter that required wiring. Complications related to implant removal can be encountered, and the orthopedic surgeon should be aware of removal techniques.
    European Journal of Orthopaedic Surgery & Traumatology 07/2013; · 0.18 Impact Factor
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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.
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