Keywords
replacement
trochanteric fracture
failure of fixation
How to Cite
Abstract
Background: Total hip replacement (THR) is one treatment option for failed hip fracture fixation. It is considered as a salvage procedure for older patients, patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage.
Patients and Methods: Total hip replacement was done for forty patients with failed internal fixation of trochanteric femoral fractures, 28 males and 12 females completed the follow up and six patients were lost. The procedure was carried out through a lateral exposure in all cases. Harris hip score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits.
Results: The mean time of follow up was 48 months (range from 36-72 months). The mean Harris hip score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Twenty-eight patients (70%) could freely walk outdoors using a cane or elbow crutch; eight patients (20 %) had a limited walking ability using two axillary crutches, and four patients (10 %) were able to walk indoors only.
Conclusion: Total hip arthroplasty is a good salvage procedure after failed internal fixation of trochanteric femoral fractures. Individual selection of the implant depends upon the age of patient, level of activity, the bone stock of proximal femur, and the condition of the acetabulum. To maintain stability, reattachment of the greater trochanter should be done. To avoid intraoperative fractures of osteoporotic bone, dislocation of the hip should be very careful.
References
2) Ruecker AH, Rupprecht M, Gruber M, Gebauer M, Barvencik F, Briem D. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma. 2009; 23:22-30.
3) Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of cutout of a lag screw of a dynamic hip screw in an intertrochanteric fracture. Arch Orthop Trauma Surg 1998; 117:193-6.
4) Haidukewych G J; Daniel B J. Hip Arthroplasty for Salvage of Failed Treatment of Intertrochanteric Hip Fractures, J Bone Joint Surg 2003; A, 85 (5): 899 -904.
5) Alvarez DB, Aparicio JP, Fernández EL, Múgica IG, Batalla DN, Jiménez JP. Implant breakage, a rare complication with the gamma nail. A review of 843 fractures of the proximal femur treated with a gamma nail. ActaOrthopBelg 2004; 70:435-43.
6) Anglen JO. Intertrochanteric osteotomy for failed internal fixation of femoral neck fracture. Clin Orthop Relat Res. 1997; 341:175-82.
7) Said GZ, Farouk O, El-Sayed A, Said HG. Salvage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury. 2006; 37: 194-202.
8) Javahir A P, Vikram I.S, Ashish N S, Kalpesh P S, Dhiraj P M, Rahul P. Hip arthroplasty in failed intertrochanteric fractures in elderly; Indian J Orthop. 2013; Vol: 47(6) P: 572-577.
9) Syed S. N.; Mehroze Z.; and Muhammad K. R. N. Total Hip Arthroplasty in Failed Hip Fractures: A Case Series; Reconstructive Review. 2015; Vol. 4, No. 4, Dec 2014.
10) Haentjens P, Casteleyn PP, Opdecam P. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg, 1994; 113: 222-7.
11) Goldstein WM, Branson JJ. Modular femoral component for conversion of previous hip surgery in total hip arthroplasty. Orthopedics. 2005; 28 Suppl 9:s1079-84.
12) Laffosse JM, Molinier F, Tricoire JL, Bonnevialle N, Chiron P, and Puget J. Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients. ActaOrthopBelg 2007; 73:729-36.
13) Mears DC, Durbhakula SM, Velyvis JH. Reconstructive total hip replacement after proximal femoral injuries. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal Trauma. Philadelphia, PA.; Saunders. 2003; p. 1817.
14) Patterson BM, Salvati EA, Huo MH. Total hip arthroplasty for complications of intertrochanteric fracture. A technical note. J Bone Joint Surg. 1990; 72A: 776-777.
15) Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture: treatment by mold arthroplasty. J Bone Joint Surg; 1969.51A: 737-755.
16) Anna N and Ann B (2011): Measures of Hip Function and Symptoms; Arthritis Care & Research Vol. 63(S11), pp S200–S207.
17) Engh CA, Bobyn JD, Glassman AH.: Porous coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg. 1987; 69B; 45-55.
18) Gruen TA, McNeice GM, Amstutz HC: Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop. 1979; 141:17.
19) DeLee, J. G., and Charnley, J. Radiological demarcation of cemented sockets in total hip replacement. Clin. Orthop.1976; 121:20-32.
20) Brinker MR, Rosenberg AG, Kull L. Primary non-cemented total hip arthroplasty in patients with ankylosing spondylitis, clinical and radiographic results at an average follow-up period of 6 years. J Arthroplasty 1996; 11:802.
21) Brooker AF, Bowerman JW, Robinson RA: Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg 1973; 55A: 1629-1632.
22) Xiaojun S, Zongke Z, Jing Y, Bin S, Pengde K, and Fuxing P. Total Hip Arthroplasty Using Non-Modular Cementless Long-Stem Distal Fixation for Salvage of Failed Internal Fixation of Intertrochanteric Fracture; J of Arthroplasty. 2015; Vol 30, (11), P: 1999–2003.
23) Thakur RR, Deshmukh AJ, Goyal A, Ranawat AS, Rasquinha VJ, Rodriguez JA. Management of failed trochanteric fracture fixation with cementless modular hip arthroplasty using a distally fixing stem. J Arthroplasty 2011; 26:398-403.
24) Zhang B, Chiu KY, Wang M. Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplasty 2004; 19:329-3
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.