TOTAL HIP ARTHROPLASTY FOLLOWING FAILED FIXATION OF PROXIMAL HIP FRACTURES

Hesham Mohamed Safwat*

ABSTRACT

Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. Aim of the work: The study was conducted to assess the results and complications of total hip arthroplasty after mechanical failure of internally fixed proximal hip fractures. Patients and Methods: In a prospective study, 21 hips in 20 patients (13 males and seven females) with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 52 years (range 44 years to 68 years). Nine hips were treated for femoral neck fracture, 10 for intertrochanteric (I/T) fracture and two for subtrochanteric (S/T) fracture of the hip. Uncemented THA was done in 7 hips, cemented THA in nine hip joints and hybrid THA in five hips. Results: The average duration of follow-up was 20 months range (6months-2.5 years) . The mean duration of surgery was 125 min and blood loss was 1200 ml. There were one dislocation post operatively. This was managed conservatively. There was one superficial infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from average 32 pre-operatively to average 82 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

Keywords: Failed internal fixation, hip arthroplasty, hip fractures, THA.