Conversion total hip arthroplasty with a proximally modular, distal fixation reconstruction prosthesis following cephalomedullar nail failure

Abstract

Background: The goals of intertrochanteric hip fracture (IHF) treatment are stable fixation, early mobilisation and function restoration. If the attempt to reduce, stabilise and fracture healing utilising a femoral cephalomedullar nail (CMN) fails, options for subsequent attempts are limited. Purpose: Evaluate the clinical and radiographic outcomes of conversion total hip arthroplasty (THA) using a modular stem following a CMN failure. Materials and methods: We retrospectively reviewed a consecutive series of patients with an IHF between 2012 and 2014 to identify CMN patients that went on to the subsequent failure and conversion to THA utilising a modular femoral stem (MFS). In all cases, MP Reconstruction Prosthesis (Waldemar Link, Hamburg, Germany) was implanted. Primary clinical outcomes were assessed using Harris Hip Score (HSS) before conversion procedure, 3 months, 6 months and recent office visit post-conversion THA thereafter. The secondary outcome was to analyse intra and postoperative complications. Serial radiographs at each follow-up interval were assessed for clinical success or to confirm adverse events. Results: 28 patients were included in the study; 17 were females. The average age was 72.7 years (SD ± 10.5); the average time from the index procedure to conversion THA was 12.6 months (SD ± 3.5). At baseline, average HHS was 42.1 (SD ± 3.6), improved to 80.7 (SD ± 5.1) at 3 months, 86.0 (SD ± 3.9) at 6-months which levelled off to 86.1 (SD ± 4.0) at final follow-up. There were 4 (14%) post-conversion complications: 2 dislocations, 1 superficial wound infection, 1 patient with symptomatic abductor deficiency. All 4 cases were conservatively treated successfully, the implants were retained, and the patients progressed without further issue. Conclusions: MFSs allow to successfully treat failed CMN and adverse variations in femoral anatomy with a device that will permit simultaneous correction of leg length, offset and version to relieve pain, restore function and create a durable prosthetic to host composite.

Salvage Hip Arthroplasty in Nail Failure: A Systematic Review

“…No additional records were included. After screening for eligibility criteria, four articles were selected and included in this study (Figure 1) [24][25][26][27], and all reported on the outcomes and complications following conversion arthroplasty after femoral nail failure in intertrochanteric femoral fractures.…”

“…The total amount of 483 cases included 476 conversion total hip arthroplasties and 7 conversion partial hip arthroplasties. The surgical approach used for the salvage procedure was not reported in two studies [25,26], while one reported a postero-lateral approach [27] and the other reported an extended direct lateral approach on previous scars [24]. The implant and type of fixation in revision surgery were reported at various levels of detail in each paper.…”

“…The implant and type of fixation in revision surgery were reported at various levels of detail in each paper. The uncemented total hip arthroplasties were 214, the hybrid ones were 134, the cemented ones were 100 and the partial hip arthroplasties were 7; in one paper [27] were reported 28 implants with various fixation types, but it was not possible to understand the combination of single elements. All the specific types of prosthetic implants used for the salvage procedure were reported in all included studies.…”

A Comparative Study of Hip Arthroplasty and Closed Reduction Proximal Femur Nail in the Treatment of Elderly Patients with Hip Fractures

“…Surgery is currently the preferred treatment protocol recommended for hip fracture patients ( 5 – 7 ). Internal fixation and artificial hip arthroplasty are the main surgical methods for hip fracture surgical treatment, and the advantages are not only reduced trauma and shortened bed time, but also significantly reduced the incidence of complications, promoted functional recovery of the hip joint and improved the life quality of hip fracture patients ( 9 , 10 ).…”

“…Currently, proximal femur nail and hip arthroplasty are widely used in the treatment of hip fractures due to their suitability for various types of hip fractures, simple surgery, low blood loss, and low trauma ( 9 , 10 ). However, many clinical studies have compared the efficacy of proximal femur nail and hip arthroplasty in the treatment of hip fractures, but the results have been inconsistent or even opposite ( 11 , 12 ).…”