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

Mahmoud, Samer S.S.; Pearse, Eyiyemi; Smith, Toby; Hing, Caroline B.

doi:10.1302/0301-620x.98b4.36922

Cited by 59 publications

(40 citation statements)

References 23 publications

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“…With the exception of very few patients with severe functional limitations, hemiarthroplasties should never be used for non-elderly patients, due to the risk of acetabular erosion [42] associated with high activity levels during many remaining life years. The salvage procedure has been shown to be associated with more complications than patients having primary THA, though this may be explained by selection bias [43].…”

Section: A C C E P T E Dmentioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!

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Section: A C C E P T E Dmentioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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“…[3][4][5][6][7][8] Moreover, treatment of proximal femoral fracture is associated with high complication rates (up to 35%) due to multifactorial and often patient-related factors as well as fracture etiology. 3,9,10 Osteosynthesis failure is considered a major complication, which necessitates changing or replacing the device to prevent further complications. In the latter one, total hip arthroplasty (THA) or hemiarthroplasty is necessary as a "salvage" procedure to maintain hip joint mobility and stability.…”

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients

Müller

Galler

Zellner

et al. 2017

J Orthop Surg (Hong Kong)

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“…e incidence of infection and dislocation following THA for femoral neck fractures are probably the same as those in the general population, but we do not have the data to back this assumption. However, salvage THA after failed internal fixation of the neck fracture is associated with higher complication rates [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

Moerenhout

Gkagkalis

Laflamme

et al. 2019

Advances in Orthopedics

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Femoral neck stress fractures (FNSFs) can be treated conservatively or surgically, depending on initial displacement and patient condition. Surgical treatment options include internal fixation, with or without valgus osteotomy or hip arthroplasty, either hemi or total. The latter is mainly considered when initial treatment fails. A review of the literature shows that total hip arthroplasty (THA) is only considered as primary treatment in displaced fractures (type 3) in low-demand patients. We present a case of successive bilateral FNSF in a young active patient, where a THA was performed on one side, after failed internal fixation, and where it was chosen as primary treatment on the other side after failed conservative treatment.

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

Cited by 59 publications

References 23 publications

Hip fractures in the non-elderly—Who, why and whither?

Hip fractures in the non-elderly—Who, why and whither?

Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

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