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: 2.67). 07/2011; 27(1):31-6. DOI: 10.1016/j.arth.2011.05.014
Source: PubMed


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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    • "Several reports have documented varying results using conventional hip stems as a salvage procedure (Mehlhoff et al. 1991, Haentjens et al. 1994, Tabsh et al. 1997, Haidukewych and Berry 2003, Zhang et al. 2004, Hammad et al. 2008, Mortazavi et al. 2012). Often, the conversion to THA does not allow the use of conventional femoral components for various reasons. "
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    ABSTRACT: Background and purpose Treatment options for failed internal fixation of hip fractures include prosthetic replacement. We evaluated survival, complications, and radiographic outcome in 30 patients who were operated with a specific modular, uncemented hip reconstruction prosthesis as a salvage procedure after failed treatment of trochanteric and subtrochanteric fractures. Patients and methods We used data from the Swedish Hip Arthroplasty Register and journal files to analyze complications and survival. Initially, a high proportion of trochanteric fractures (7/10) were classified as unstable and 12 of 20 subtrochanteric fractures had an extension through the greater trochanter. Modes of failure after primary internal fixation were cutout (n = 12), migration of the femoral neck screw (n = 9), and other (n = 9). Results Mean age at the index operation with the modular prosthesis was 77 (52–93) years and the mean follow-up was 4 (1–9) years. Union of the remaining fracture fragments was observed in 26 hips, restoration of proximal bone defects in 16 hips, and bone ingrowth of the stem in 25 hips. Subsidence was evident in 4 cases. 1 patient was revised by component exchange because of recurrent dislocation, and another 6 patients were reoperated: 5 because of deep infections and 1 because of periprosthetic fracture. The cumulative 3-year survival for revision was 96% (95% CI: 89–100) and for any reoperation it was 83% (68–93). Interpretation The modular stem allowed fixation distal to the fracture system. Radiographic outcome was good. The rate of complications, however—especially infections—was high. We believe that preoperative laboratory screening for low-grade infection and synovial cultures could contribute to better treatment in some of these patients.
    Full-text · Article · Oct 2012 · Acta Orthopaedica
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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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