Salvage total hip arthroplasty after failed internal fixation for proximal femur and acetabular fractures

Abstract

Background Total hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear. Questions/purposes The primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip. Patients and methods We enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip. Results A total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications. Conclusion Salvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III

Treatment Failure After Repair of Displaced Femoral Neck Fractures in Patients Compared by “Decade of Life”: An Analysis of 565 Cases in Adults Less Than 60 years of Age

“…5 Although we are unable to conclude that there is a relationship between the number of TEs seen and patient age as the data in this category did not meet the criteria for significance, previous studies have highlighted the importance of TEs and their association with failure. 44,45 Collinge et al studied 492 FNFs in patients ,50 years of age and found that treatment failure occurred in 27% of cases without a TE, 57% with 1 TE, 84% with 2 TEs, and 100% with 3 TEs (P , 0.001). 46 Thus, surgeons should maintain a high level of caution during repair and continue to keep themselves up to date with evidence-based guidelines.…”

Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications

“…In a somewhat related consideration, femoral neck fractures stabilized with percutaneous screw fixation are at greater risk of adverse events after THA if conversion is later needed. [8][9][10] Given the wide range of reported rates of conversion from core decompression to THA, there is a need to investigate/study this special population and to better characterize the outcomes of potential subsequent THA after core decompression with a larger sample size, longer follow-up, and tracking of more specific THAassociated complications. This study aimed to address these points by leveraging a large, national, multiinsurance administrative database.…”

“…In a somewhat related consideration, femoral neck fractures stabilized with percutaneous screw fixation are at greater risk of adverse events after THA if conversion is later needed. 8-10…”