Conversion hip arthroplasty in the treatment of adverse effects of proximal femoral fractures

Abstract

INTRODUCTION. Currently, there are no uniform algorithms for surgical tactics of conversion hip arthroplasty.The OBJECTIVE was to evaluate the mid-term results of conversion hip arthroplasty in patients with adverse effects of proximal femoral fractures.METHODS AND MATERIALS. A retrospective study of the treatment results of 58 patients who underwent conversion hip arthroplasty was conducted. All patients underwent bacteriological examination before and during surgery, blood tests for ESR and CRP. Patients were divided into two groups: Group 1 (low risk of infections) – 29 patients in one stage, group 2 (high risk of infections) – 29 patients with a two-stage technique using a cement spacer. Randomization criteria: positive preoperative culture, elevated CRP (>10 mg/L) and ESR (>30 mm/hour). Efficacy was assessed using the visual analogue pain scale and Oxford Hip Score after 6, 12 and 24 months, as well as the frequency and nature of complications.RESULTS. The average age of patients was 58.7 years. The average follow-up period was 4.5±1.3 years. The average surgery time – 115 minutes in group 1 and 100 minutes in group 2. The average blood loss was 650±123 ml in group 1 and 630±108 ml in group 2. Pain syndrome according to the VAS scale after 6, 12 and 24 months was 2.5–1.2–1.2 points in both groups, respectively (p=0.001). Periprosthetic hip fracture occurred in 7 cases (12 %); dislocation – in 1 case (1.7 %); deep infection – 3 patients (5.1 %); aseptic loosening – in 2 cases (3.4 %). Revision arthroplasty was required in 5 cases (8.6 %).CONCLUSION. The mid-term results of conversion arthroplasty are significantly lower compared to the results of primary arthroplasty. Conversion is associated with a higher number of intraoperative hip fractures and infections. The use of a two-stage conversion technique with temporary installation of a cemented spacer allows to reduce the number of infectious complications after the final arthroplasty by 3 times.