Hip arthroplasty for failed internal fixation of intertrochanteric fractures

Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

“…The functional scores observed in patients undergoing GEA as a result of infected total hip replacements [5] is considerably less than that of patients following twostage revisions for infection [6]. Hip replacement for failed internal fixation of intertrochanteric fractures also demonstrates far better functional outcomes than would be expected following GEA [7]; reimplantation has also been shown to be functionally superior to GEA [8].…”

“…Mean time from initial injury to EPR was 34 (6-102) months, and median number of previous operations was two (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). All patients had sustained traumatic fractures of the proximal femur-four 31.A2.3, The ultimate failed internal fixation was a dynamic hip screw in three cases (Fig.…”

Salvage total hip arthroplasty (THA) for failed internal fixations of proximal hip fractures

“…Zhang et al encountered an overall complication rate of 47% while treating intertrochanteric fractures with hip arthroplasty. 27 Despite advances in internal fixation methods have now lowered the percentage of failures of internal fixation, still fixation of unstable, comminuted and subtrochanteric fractures in elderly and osteoporotic patients carries high chances of failure. 28 In such cases salvage THA appears to be the best treatment options as it allows immediate ambulation with minimal complications.…”

“…17 Structural defects and modifications of bony landmarks due to deformation and displacement of fragment combined with poor bone quality, loss of bone stock and presence of holes after removal of internal fixation hardware all encourages intraoperative mechanical complications (fracture and cortex perforations). 17 [18][19][20][21][22][23][24] A long cemented or cementless long stem is helpful to bypass cortical defects and/or screw holes left at the site of failed fixation. 25 Every case of salvage THA is unique and surgical plan should be tailored as per preoperative assessment.…”

“…1 The failure of internal fixation methods may be due to various reasons like non-union, loss of fixation, femoral head osteonecrosis, post-traumatic arthritis, malunion, infection or symptomatic hardware. [2][3][4][5][6][7][8][9][10] Simultaneous evolution of advanced methods of internal fixation of femoral neck and intertrochanteric fractures have reduced failure rates (2-3%) but in elderly and osteoporotic patients it still carries high risk of failure. 11,12 Conversion arthroplasty in such failed fixations also known as salvage THA appears to be the promising treatment as it allows immediate ambulation and prevention of age related complications.…”