Conjoint Removal of Hip Screw–Femur Head during Hip Replacement after Previous Dynamic Hip Screw Fixation

Abstract

The purpose of this study was to demonstrate the reduced chances of iatrogenic femoral neck fracture while removing the Richard's screw using the dynamic hip screw–femur head conjoint removal technique. This retrospective cohort study analyzed 16 hips operated on with total hip arthroplasty from March 2010 to February 2015. All cases were previously treated with dynamic hip screws (DHS) for proximal femur fractures. The age of the patients ranged from 20 to 75 years. We used uncemented sockets in 15 patients and cemented sockets in 1 patient. We used conical fluted straight stems in 9 cases, ML (Mediolateral) tapered stems in 5 patients and CLS (Cementless Spotorno) stems in 2 patients. The head of the femur was removed together with the attached Richard's screw after taking a neck cut during hip replacement after previous dynamic hip screw fixation. At 2‐year follow‐up, there was a statistically significant improvement in the Harris hip score: from a mean preoperative score of 35 ± 7.975 to a mean postoperative score of 89.38 ± 4.870 (P < 0.001). Stem sinking and Type AL (Vancouver classification for periprosthetic fracture) periprosthetic fracture in 1 patient with a tapered stem was noted. Good acetabular inclination was achieved in all cases. At 2‐year follow‐up, all patients were able to carry out their daily activities. This is a novel technique with the advantage of avoiding iatrogenic femoral neck fracture in an osteoporotic bone.