Cementless total hip arthroplasty following failed internal fixation for femoral neck and intertrochanteric fractures: A comparative study with 3–13 years’ follow-up of 96 consecutive patients

Moon, Nam Hoon; Shin, Won Chul; Kim, Jung Shin; Woo, Seung Hun; Son, Seung Min; Suh, Kuen Tak

doi:10.1016/j.injury.2019.01.018

Cited by 16 publications

(22 citation statements)

References 31 publications

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“…However, the incidence rates were lower than those reported by Moon, which could be attributed to factors such as internal fixation and rigid external fixation. 12,13 Blood flow to the pediatric femur head has specific characteristics. 1,2,14 In infants, the metaphyseal artery from arteriae circumflexae femoris lateralis and arteriae circumflexae femoris medialis passes through the femoral proximal epiphyseal growth plate and supplies femoral head.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and complications after delayed fixation of femoral neck fractures in children

Ning

et al. 2019

J Orthop Surg (Hong Kong)

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Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

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Section: Discussionmentioning

confidence: 99%

Efficacy and complications after delayed fixation of femoral neck fractures in children

Ning

et al. 2019

J Orthop Surg (Hong Kong)

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“…Successful femoral component fixation can be achieved with either cemented or cementless implants [21,30,32]. In a series of 33 conversion arthroplasties, cementless prostheses were used due to a concern for cement-related cardiopulmonary complications [6].…”

Section: Conversion Hip Arthroplastymentioning

confidence: 99%

“…The femoral canal can be opened using a high-speed burr and hand reamed with the reamer length selected according to the preoperative templating to obtain an optimal endosteal contact in the distal diaphyseal part of the femur. A C-arm image intensifier or fluoroscopic image intensifier is helpful in guiding this process, as the index surgery can result in an abnormal proximal femoral anatomy, medullary canal obstruction and stress-riser formation [10,30].…”

Section: Technical Challenges and Considerationsmentioning

confidence: 99%

“…Reaming acetabular cartilage judiciously and aiming to preserve the subchondral bone are recommended. Forceful acetabular component impaction is not allowed; [19,38] Removal of previous fixation devices Dislocating the hip joint before removing; excising the femoral head with the lag screw in situ [6,41] Removal of broken screws Trephines, grasping tools, a standard broken screw removal set and a metal-cutting high-speed burr [37,40] Revision internal fixation Avoiding a varus malreduction and obtaining stable fixation (compression technique and bone grafting) [2,19,42] Bone deformity of proximal femur Restoring the relationship between the tip of greater trochanter and the center of femoral head rotation [19] Femoral canal preparation for revision arthroplasty Endosteal sclerotic bone removal: gauge osteotome and/or a burr; refereing horizontal axis of the knee joint to adjust the anteversion of the stem; using C-arm image intensifier or fluoroscopic image intensifier to guide the placement of the stem [6,10,30] Bone defect of proximal femur Calcar-replacing and long-stem implant combined with or without a prophylactic cable; tumor-type endoprosthesis [17,39,44,46] Leakage of cement through screw holes Finger pressure, packed gauze, re-inserted screws, surgical glove inflated with saline, fashioned bone plug [47,48] Acetabula preparation in patients with poor bone quality…”

Section: Technical Challenges and Considerationsmentioning

confidence: 99%

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Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art

Liu

Jin

Zhang

et al. 2020

BMC Musculoskelet Disord

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Failed treatment of intertrochanteric (IT) femoral fractures leads to remarkable disability and pain, and revision surgery is frequently accompanied by higher complication and reoperation rates than primary internal fixation or primary hip arthroplasty. There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. Salvage options are determined according to patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency. In physiologically young patients, care should be taken to preserve the vitality of the femoral head with salvage internal fixation; however, for the elderly population, conversion arthroplasty can result in early weight bearing and ambulation and eliminates the risks of delayed fracture healing. Technical challenges include a difficult surgical exposure, removal of broken implants, deformity correction, critical bone defects, poor bone quality, high perioperative fracture risk, and prolonged immobilization. Overall, the salvage of failed internal fixations of IT fractures with properly selected implants and profound techniques can lead to the formulation of valuable surgical strategies and provide patients with satisfactory clinical outcomes.

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“…Total hip arthroplasty (THA) is accepted as a successful salvage procedure for failed xation of the subtrochanteric fractures [9]. In cases of failure caused by cut-out screws, damage of the acetabular cartilage, and degenerative changes of articulation, THA can reduce the need for subsequent reoperation [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

Jin

Kim

et al. 2020

Preprint

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Background Failed treatment of subtrochanteric fractures commonly leads to pain, limping, and poor function. Cementless total hip arthroplasty (THA) could be an option as a salvage procedure in such cases. This study was to evaluate the clinical and radiological results and complications of this treatment in our hospital. Method Eighteen cementless THAs for failed treatment of subtrochanteric fractures were performed at our institution between January 2001 to December 2017. There were eleven males and seven females, and the average age was 74 years (range 57.0-89.0). Eight patients were previously operated with an intramedullary nail, six patients were treated with a dynamic hip screw, two patients were treated with an angled blade plate, one patient was treated with a proximal femur locking plate, and one patient was treated with a dynamic compression plate. Results The mean follow-up was 5.2 years (range 2.2-10.8). The mean duration of the operation was 98.0 minutes (standard deviation [SD],15.4; range 70-135). The mean total blood loss was 992.2 mL (SD,171.2; range 640-1260 mL), and the amount of transfusion was 2.2 units (SD, 0.8, range 1-4). The mean Harris hip score (HHS) was 38.2 (SD, 9.3; range, 24-56) preoperatively and 85.4 (SD, 4.9; range, 79-92) at the last follow-up. Compared to the patients treated with plate-screws, those treated with an intramedullary nail had significantly shorter surgical duration, fewer blood transfusions, and less intraoperative blood loss. Kaplan-Meier survivorship with an endpoint of revision was 94.4% (95% confidence interval 72.7-99.9) at five years. Conclusion Cementless THA is one of the acceptable procedures for failed treatment of the subtrochanteric fracture with fewer complications.

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Cementless total hip arthroplasty following failed internal fixation for femoral neck and intertrochanteric fractures: A comparative study with 3–13 years’ follow-up of 96 consecutive patients

Cited by 16 publications

References 31 publications

Efficacy and complications after delayed fixation of femoral neck fractures in children

Efficacy and complications after delayed fixation of femoral neck fractures in children

Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art

Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

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