Total hip arthroplasty for failed aseptic Austin Moore prosthesis

Abstract

Background:Though Austin Moore (AM) replacement prosthesis has fairly good short term results for intracapsular femoral neck fractures in the elderly, it still is a compromised option and has a high failure rate in the long run. The objective of the present retrospective study is to analyze the functional outcome, assess survivorship of revision total hip arthroplasty (THA) at mid to long term followup, and evaluate intraoperative difficulties faced during conversion of failed aseptic AM prosthesis to cemented THA.Materials and Methods:Eighty-nine cemented THA surgeries for failed AM prosthesis were performed between 1986 and 2005. AM failures were classified into seven groups on the basis of mode of failure. Infected failures were excluded from the study. There were 35 men and 54 women in the study group. The mean age was 68 years (range 57–91 years). Mean followup was 8 years (range 5–13 years).Results:Average Harris Hip Score improved from 65 preoperatively (range 42–73) to 87 (range 76–90) at 1 year postoperatively and to 86 (range 75–89) at the last followup. The overall complication rate was 4.5%.Conclusion:Conversion THA is an excellent treatment strategy for symptomatic failed AM hemiarthroplasty in terms of pain relief and restoration of function and mobility as near as possible to the preinjury level. Also, hemiarthroplasty should not be used in physically active patients, even in elderly individuals. Careful patient selection for hemiarthroplasty versus THA is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.

Results of Conversion from Failed Austin-Moore Hemiarthroplasty to Cementless Total Hip Arthroplasty in Octogenarian Patients with Advanced Acetabular Erosion: A Minimum of 5 Years of Follow-Up

“…Austin-Moore HA had been selectively used for elderly patients with femoral neck fractures [3–9]. However, a poor quality of life and unsatisfactory results reportedly affect as many as 48% of physically active elderly patients [8]. The reported percentage of prosthesis survival ranges from 2% to 10% at mid-term follow-up and from 6% to 35% at long-term follow-up [10–15].…”

“…Grosso et al [21] reviewed the best available evidence in the literature and concluded that a cemented, unipolar HA should be reserved for low-demand elderly patients. However, the relatively low cost and good short-term outcomes have resulted in widespread use in inappropriate patients [7, 8]. With increasing life span and activity, the number of failed Austin-Moore HA procedures is increasing [6–9].…”

“…Cossey and Goodwin reported that 88% of patients had satisfactory outcomes at 1 year of follow-up [6], and Pankaj et al [7] reported a significant functional improvement from an HHS of 38 to 86 at an average 6.4 years of follow-up. Bhosale et al also reported an improvement in HHS from 65 to 87 after conversion of failed Austin-Moore HA to THA [8]. However, few reports have evaluated the mid-term results of cementless THA in the treatment of advanced acetabular erosion in octogenarians [8].…”

“…Bhosale et al also reported an improvement in HHS from 65 to 87 after conversion of failed Austin-Moore HA to THA [8]. However, few reports have evaluated the mid-term results of cementless THA in the treatment of advanced acetabular erosion in octogenarians [8]. In octogenarian patients, coexisting osteoarthritis and osteoporosis may contribute to faster destruction of acetabular cartilage and advanced acetabular erosion.…”

“…Osteotomy over dome area should be avoided to prevent inadequate support of later acetabular shell implantation (Figure 1). Care was taken to check synchronous motion of the femur with the prosthesis to avoid a periprosthetic fracture [8]. To remove the prosthesis from the femur, the femoral component can be loosened and removed simply by using a commercially available extraction device.…”