Functional outcome of total hip arthroplasty after failed hemiarthroplasty

Abstract

Background: The long term follow up results of hemiarthroplasty (unipolar or bipolar) for fracture neck of femur are not promising due to high incidence revision. The objective of this study is to provide useful information on the mode of failure of hemiarthroplasty in those who required revision, and the magnitude and complications of conversion total hip arthroplasty.Materials and Methods: Twenty two cases, 14 women and 8 men, average age 61 years (range 42-75 years) of failed hemiarthroplasty were converted to total hip replacement between June 2011 and January 2015. Thigh pain was the main presenting complaints in the majority of the patients (10 out of 22).Two patients had infection and were operated with staged procedure. All acetabular and the majority (86.5%) of femoral components used in our series were uncemented.Results: After an average follow-up of 41 months (Range, 13-86 months) Harris hip scores improved from 36.4 (range 28-42) preoperatively to 84.7 (range 69 to 98) postoperatively. We had 19 patients with no hip pain and 3 patients with slight pain. Also, at the last follow up 19 (86.3%) patients were community ambulators without support while 3 (13.6%) needed minimal support of cane. Range of motion improved significantly and was essentially normal in all. Postoperative complications included persistent groin pain in 2 patients, superficial infection in one, and sciatic nerve neuropathy in one patient which recovered completely in one year. In the last follow-up of conversion total hip prosthesis, there was no radiolucency in either femoral or acetabula components.Conclusion: Total hip arthroplasty can be reliable in eliminating groin pain following failed hemiarthroplasty and modular bipolar hemiarthroplasty is recommended in middle aged patients with fracture neck of femur and in elderly patients with active life style with femoral neck fractures, primary total hip arthroplasty has better results.