Total hip arthroplasty after failed treatment of proximal femur fracture

Fujiwara, Kazuo; Endo, Hidenori; Noda, Tomoyuki; Tetsunaga, Tomonori; Satô, Tôru; Shiota, Naofumi; Ozaki, Toshifumi

doi:10.1007/s00402-017-2631-0

Cited by 42 publications

(24 citation statements)

References 30 publications

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“…Abductor muscle insufficiency, trochanteric malunion, and the lack of restoration of vertical and lateral offset associated with dislocation are potential reasons for complications after salvage hip arthroplasty. [15,[18][19][20][21] Weaknesses of our study are the retrospective design and small sample size. A different feature of our study from others is that the mean age is >65 years in the literature, while the mean age of the patients in our group was 57 years.…”

Section: Discussionmentioning

confidence: 96%

“…Franzén et al [20] noted greater risk in patients over 70 years of age, but noted that the complication rate was similar to that of primary THA for treatment of a collum femoris fracture. Recently, Tetsunaga et al [21] presented their research comparing the results of THA after failed pertrochanteric and collum femoris fractures, and they observed that THA after a failed collum femoris fracture had a lower complication rate. Abductor muscle insufficiency, trochanteric malunion, and the lack of restoration of vertical and lateral offset associated with dislocation are potential reasons for complications after salvage hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of salvage total hip arthroplasty after failed osteosynthesis for collum femoris fractures

Akgül

Birişik²,

Polat

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: This study is an investigation of the outcomes of salvage total hip arthroplasty (THA) to treat collum femoris fractures that resulted in complications or failure after osteosynthesis. METHODS: Twenty patients (6 male, 14 female; mean age: 56.7 years) who underwent salvage total hip arthroplasty (THA) between 1988 and 2012 due to failure developing after closed reposition and osteosynthesis in the treatment of collum femoris fractures were included in the study. The type of osteosynthesis, and the length of time until failure and before THA application after collum femoris fracture were recorded. Cementless acetabular and femoral components were used in all of the patients. Complications were defined as those occurring during and after surgery. The clinical results were assessed with the Harris Hip Score (HHS) and the presence of loosening was assessed with radiological evaluation in follow-up. RESULTS: The mean length of the follow-up period was 59.4 months (range: 15-178 months). The collum femoris fractures of the 20 patients were classified as: 5 Garden type II, 13 type III, 2 type IV, and 3 Pauwels type I, 8 type II, and 9 type III. Cannulated screws were used in 13 patients (65%) and dynamic hip screw (DHS) fixation was used in 7 patients (35%). Complications observed after osteosynthesis were nonunion in 4 cases (20%), malunion in 2 (10%), avascular necrosis in 10 (50%), and implant failure in 4 (20%). A mean of 9.66 months (range: 3-54 months) elapsed before osteosynthesis failure and the mean length of time until THA was 31.6±51.7 months. There was no statistically significant difference between cannulated screw and DHS fixation in the development of complications (p=0.084). Early dislocation (5%), periprosthetic fracture (5%) and acetabular protrusion (5%) were recorded as complications. A revision was made upon determination of loosening in the 10th year in the patient who developed early dislocation. While the mean HHS was 54.05±8.22 before THA, it was evaluated to be 86.45±8.73 at the last follow-up, which was a statistically significant difference (p<0.0001). CONCLUSION: The study findings demonstrated that THA applied with suitable surgical technique is a safe and successful method that may be used after failed osteosynthesis in cases of collum femoris fracture.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Outcomes of salvage total hip arthroplasty after failed osteosynthesis for collum femoris fractures

Akgül

Birişik²,

Polat

et al. 2018

Ulus Travma Acil Cerrahi Derg

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“…While our analysis was able to statistically validate the difference in the HHS, it failed to validate the differences in the rate of major orthopaedic complications during the first 2 years, most likely owing to the short follow-up. The long-term outcomes of CTHA or UTHA for patients with failed PFNA is a matter of great debate [22]. However, a growing but still very limited body of literature has investigated the therapeutic role of these two endoprostheses in the setting of failed PFNA and has suggested that the differences between CTHA and UTHA were attributed to errors in surgical techniques or indications [23].…”

Section: Discussionmentioning

confidence: 99%

Cemented versus uncemented total hip arthroplasty for failed proximal femoral nail anti-rotation fixation in patients with intertrochanteric femur fractures: 5-year results of a retrospective observational study

Chen

Mao

Lin

et al. 2020

Preprint

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Background: Cemented or uncemented total hip arthroplasty (CTHA or UTHA) is being increasingly performed in patients with intertrochanteric femur fractures (IFFs) who failed to be treated with proximal femoral nail anti-rotations (PFNA) fixation. The purpose of this study is to compare the clinical outcomes of CTHA or UTHA following prior failed PFNA fixation in patients with IFFs.Methods: Data from 244 patients with IFFs who underwent a conversion of PFNA to CTHA (PCA, n =120) or to UTHA (PUA, n = 124) due to pain and hip disfunction during 2008-2018 were retrospectively analysed. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The mean follow-up was 64 months (range, 57 -71 months). The Harris hip score (HHS) was the primary outcome; the incidence of major orthopaedic complications was the secondary outcome. Results:At the final follow-up, HHS was 79.54±18.85 vs 75.26±18.27 (PCA vs PUA, p = 0.014). There were significant differences between groups regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (5.8% for PCA vs 14.5% for PUA, p = 0.025; 10.0% for PCA vs 20.1% for PUA, p = 0.027; 3.3% for PCA vs 10.5% for PUA, p = 0.028, respectively). Conclusion:The results of the study demonstrated a significant advantage with respect to HHS and major orthopaedic complication rate in favor of CTHA, as compared to UTHA in patients with a failed PFNA treatment.

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“…4 This procedure has been shown to have high rate of complications such as intraoperative fracture and early dislocation. [5][6][7][8] However, the use of dual cup THR reduces the risk of postoperative dislocation following failed internal fixation of proximal femur fracture. 9 We present our midterm results of dual mobility (DM) THR in these high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

Dual mobility total hip arthroplasty for salvaging failed internal fixation for neck of femur fractures

Luthra

Ghannami

Habsi

et al. 2020

Journal of Orthopaedics, Trauma and Rehabilitation

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Internal fixation is commonly used to treat fractures in the hip. However, failure of proximal femoral fracture fixation is common and treated with total hip replacement (THR). The aim of this study is to present our midterm results of dual mobility (DM) THR for failed internal fixation of proximal femur fractures. Between 2010 and 2015, a total of 28 cases of failed internal fixation for hip fractures were treated through DM total hip arthroplasty. Two patients died during the early postoperative period due to medical complications. The average follow-up was 3.4 years. We had one patient with superficial surgical site infection which was managed by local wound debridement and dressings. The average Harris hip score was 85. DM THR is the procedure of choice for revising failed internal fixation for hip fractures in our patients with good clinical outcome.

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Total hip arthroplasty after failed treatment of proximal femur fracture

Abstract: Performing THA after failed treatment of trochanteric fractures requires consideration of complication risk and incorrect femoral neck anteversion.

Cited by 42 publications

References 30 publications

Outcomes of salvage total hip arthroplasty after failed osteosynthesis for collum femoris fractures

Outcomes of salvage total hip arthroplasty after failed osteosynthesis for collum femoris fractures

Cemented versus uncemented total hip arthroplasty for failed proximal femoral nail anti-rotation fixation in patients with intertrochanteric femur fractures: 5-year results of a retrospective observational study

Dual mobility total hip arthroplasty for salvaging failed internal fixation for neck of femur fractures

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