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

Abstract

THA was associated with an increased surgical revision rate, but hip dislocation was documented only once. In most cases, a standard implant with a large 36-mm femoral head size was sufficient. Uncemented revision stem revealed significantly higher number of revisions-compared to standard cemented or uncemented stem. One-year mortality was lower than expected.

Dual mobility total hip arthroplasty for salvaging failed internal fixation for neck of femur fractures

“…5,22,23 Use of larger head size can help to reduce postoperative dislocation. 24 The smaller average pelvic size in our cohort of population does not permit femoral head more than 28 mm.…”

Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art

“…Reaming acetabular cartilage judiciously; avoiding forceful component impaction; considering screws augmentation [17,37] Greater trochanter reattachment Contoured plating, tension band wiring and trochanter claw plate with wiring [11,30,35,36,46] instead, augmentation of the fixation with screws should be considered [17,37]. A separated greater trochanter, commonly seen in patients subjected to IT fixation failure, usually causes pain and limping and even affects abductor function [31,49].…”

“…Additionally, evidence has revealed that a higher dislocation rate of hip arthroplasty is correlated with displaced fracture of the greater trochanter [31]. Three methods for fixation of the greater trochanter have been mentioned: contoured plating, tension band wiring, and trochanter claw plating with wiring [11,30,31,35,36,46]. In a retrospective study of 16 failed IT fixations, all patients received surgery with HA and the cable-grip system.…”

“…No detectable wear or periprosthetic osteolysis was observed, and none of the patients underwent component dislocations. Cement fixation is more suitable for relatively elderly patients (generally more than 70 years of age), especially when bone quality is poor and the canal is capacious [ 11 , 17 ].…”

“…Failed treatment of IT fractures leads to remarkable disability and pain, which may cause complications associated with prolonged recumbency and affect the vital prognosis of these fragile patients, thereby necessitating effective surgical intervention [ 10 ]. Surgery indications include implant failure, nonunion, malunion, fracture, dislocation, femoral head necrosis, posttraumatic arthritis and infection [ 4 , 11 , 12 ]. Salvage osteosynthesis and conversion hip arthroplasty remain the mainstays of treatment for the failed internal fixation of IT fractures rather than conservative, nonoperative therapy, which is limited to incredibly infirm patients [ 13 ].…”