Salvage of failed hip osteosynthesis for fractures with modular hip prosthesis

Karampinas, Panagiotis Κ.; Kollias, George; Vlamis, John; Papadelis, Eustratios A.; Pneumaticos, Spiros G.

doi:10.1007/s00590-015-1622-5

Cited by 9 publications

(10 citation statements)

References 20 publications

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“…And hip arthroplasty was advocated as the main treatment option for salvage. [34,35] Moreover, when patients treated with arthroplasty complained about hip discomfort, we handled it with observation usually. Reoperation rate was also dependent on prevailing medical/economic/social conditions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Nie

Yang

et al. 2017

Medicine

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Background:More and more studies conduct to compare intramedullary fixation (IMF) with arthroplasty in treating intertrochanteric hip fractures, but it remains controversy. The aim of this meta-analysis was to find out whether IMF or arthroplasty was more appropriate for treating intertrochanteric hip fractures in elderly patients.Methods:Relevant studies were searched in the electronic databases of PubMed, Embase, and The Cochrane Central Register of Controlled Trials from January 1980 to September 2016 with English language restriction. Surgical information and postoperative outcomes were analyzed using RevMan 5.3 version.Results:A total of 1239 patients from 11 studies which satisfied the eligibility criteria were included. Compared with IMF, the use of arthroplasty reduced implant-related complications (odds ratio [OR]: 2.05, P = .02) and reoperation rate (OR: 7.06, P < .001), and had similar length of hospital stay (weighted mean difference [WMD]: −0.41, P = .63). However, IMF reduced blood loss (WMD: −375.01, P = .001) and transfusion requirement (OR: 0.07, P < .001), shorter operation time (WMD: −18.92, P = .010), higher Harris hip score (WMD: 4.19, P < .001), and lower rate of 1-year mortality (OR: 0.67, P = .02) compared with arthroplasty.Conclusion:The main treatment of intertrochanteric hip fractures is internal fixation using IMF. In the absence of concrete evidence, arthroplasty should be undertaken with caution in carefully selected patient and surgeon should be aware of the increased complexity of doing the arthroplasty in these elderly patients. Further high-quality randomized controlled trials (RCTs) are needed to provide robust evidence and evaluate the treatment options.

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Section: Discussionmentioning

confidence: 99%

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Nie

Yang

et al. 2017

Medicine

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“…During a mean follow-up of 20 months, all the patients reported notable pain relief and functional improvement, indicating that the modular stem was a reliable implant. Furthermore, another study involving 11 patients confirmed modular arthroplasty as an effective salvage procedure [1].…”

Section: Conversion Hip Arthroplastymentioning

confidence: 90%

“…In properly selected patients, a high rate of successful revision surgery can be achieved [ 1 , 5 , 16 ]. The decision to perform either revision osteosynthesis or prosthetic replacement is based on multiple factors: patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency (Fig.…”

Section: Salvage Optionsmentioning

confidence: 99%

“…Briefly, salvage osteosynthesis is preferable for physiologically young patients with long life expectancies and adequate bone quality for fixation; hip arthroplasty, in contrast, is preferred for the geriatric population with poor bone quality, inadequate bone stock, and severely damaged hip articular surfaces. Conversion hip arthroplasty is beneficial for early weight bearing and mobilization, eliminating the risks of delayed fracture healing and accelerating functional recovery, which are pivotal for prognosis in elderly, debilitated patients [ 1 , 2 , 10 ].

Fig.…”

Section: Salvage Optionsmentioning

confidence: 99%

“…Intertrochanteric (IT) fractures are common, accounting for almost half of all hip fractures and resulting in a great burden on orthopedic services [1][2][3]. Although most IT fractures can be treated successfully with contemporary surgical techniques and internal fixations such as intramedullary nails and sliding hip screws, clinical failures still occasionally occur, with reported data indicating a range from 0.5 to 56% depending on the fracture type, patient status, and quality of the reduction and fixation [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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Le protesi nelle fratture del collo femorale

et al. 2019

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Salvage of failed hip osteosynthesis for fractures with modular hip prosthesis

Abstract: The use of modular stems during salvage arthroplasty can decrease the risk of intraoperative and postoperative complications. The final outcome for the patient is satisfactory with functional improvement of the hip.

Cited by 9 publications

References 20 publications

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

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

Le protesi nelle fratture del collo femorale

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