Total Hip Arthroplasty After Failed Internal Fixation of Proximal Femoral Fractures

The management of intracapsular femoral neck fractures in independently mobile patients remains controversial. Successful fixation obviates the limitations of arthroplasty for this group of patients, however with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip replacement (THR) must be considered. We carried out this review to determine the outcome of salvage THR and how this compares to primary THR for fracture. We performed a PRISMA compliant systematic review using the PubMed, EMBASE and Cochrane libraries databases. A meta-analysis was performed when possible and a narrative synthesis when a meta-analysis was not possible. Our analysis revealed a significantly increased risk of complications including deep infection, early dislocation and peri-prosthetic fracture when salvage THR was compared with primary THR for an intracapsular femoral neck fracture (overall risk ratio of 3.15). Functional outcomes assessment using EQ5D were not significantly different (p=0.3).4

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“…Winemaker et al 11 Not mentioned Pin and plate (22) Cannulated Screws (14) Not Jarth. 13 Not mentioned -Four flanged nail.…”

Section: Resultsmentioning

confidence: 99%

“…13,15 Over the next two decades, Charnley and Exeter systems were the preferred cemented implants. One study did not specify the THR implant used 14 ( Table 2).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck

Mahmoud

Pearse

Smith

et al. 2016

The Bone & Joint Journal

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“…While these procedures generally have successful outcomes [3], complications such as non-union, migration of hardware, osteonecrosis of the femoral head, infection, or post-traumatic osteoarthritis do occur [5][6][7][8][9][10][11]. Failed surgical fixation of hip fractures often result in conversion THA as a salvage treatment [12].…”

mentioning

confidence: 97%

The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty

Baghoolizadeh

Schwarzkopf

2016

The Journal of Arthroplasty

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“…In the setting of AVN following a prior internal fixation, there is often added complexity in the form of retained or broken hardware, poor bone stock, difficult exposure, and the presence of deformity or non-union, all of which can further complicate an arthroplasty procedure [48,49].…”

Section: Arthroplastymentioning

confidence: 99%

Managing AVN following internal fixation: Treatment options and clinical results

Hoskinson

Morison

Shahrokhi

et al. 2015

Injury

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Total Hip Arthroplasty After Failed Internal Fixation of Proximal Femoral Fractures

Cited by 107 publications

References 14 publications

Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck

Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck

The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty

Managing AVN following internal fixation: Treatment options and clinical results

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