Causes of revision hip arthroplasty after hemiarthroplasty for femoral neck fracture

Abstract

Purpose: analyze the unsatisfactory results of using hemieprostheses and compare them with similar outcomes of total hip replacement after a femoral neck fracture among patients of older age groups. Material and methods. A retrospective randomized study was conducted, which included 36 patients who underwent revision arthroplasty after various types of arthroplasty for a femoral neck fracture. The patients were divided into 3 groups. Group 1 included 10 patients who underwent artyhroplasty using hemiprostheses. Group 2 - 15 patients with cemented acetabular components. 3rd - 11 patients who had cementless fixation acetabular components. Results. The average age of patients in group 1 was 79 years and was statistically significantly different from patients in groups 2 and 3 (74.4 and 74.9 years, respectively). The average time for revision was 40.2 months and was significantly different from the time for revisions after total cemented (82.7) as well as total uncemented (86.6). The most common bone defects were types 2C and 3A (total 41.6% in all groups). In all 100% of cases of hemiarthroplasty, errors were made in choosing the size of the acetabular bipolar or monopolar component. The use of a larger hemiprosthesis cup compared to the femoral head led to early erosion of cartilage tissue. Smaller hemiendoprosthesis cups were complicated by early protrusions of the acetabulum floor. The main errors in total arthroplasty were malposition of the acetabular component (33.3%-54.5%) and inadequate cement mantle (20%). It should be noted that infections in total among patients of the 2nd and 3rd study groups occurred up to 24.7 months after primary arthroplasty. Conclusion. Errors associated with incorrect selection of the size of the acetabular component of the endoprosthesis during primary hemiarthroplasty lead to early complications: erosion and protrusion of the acetabulum. Severe pain syndrome due to incorrect selection of the size of the acetabular component of the hemiendoprosthesis develops on average after 13.9 months, and the time period for re-endoprosthetics is 40.2 months after the initial operation. With erosions of the acetabulum, there are no bone defects; with protrusions, bone defects of type 2C and 3A more often occur.