Abstract
BackgroundIntertrochanteric fracture is a common fracture suffered by elderly patients. Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fixation failure, which remains somewhat controversial due to some clinical potential issues.Methods18 elderly patients (average age 70.3 years) each with intertrochanteric fracture fixation failure treated with THA between September 2013 and October 2016 were retrospectively analyzed. Internal fixation treatments involved 5 patients who had received proximal femoral nail anti-rotation, 7 who received locking proximal femur plates and 6 who received dynamic hip screws. All patients were treated with THA using biological acetabular prosthesis and hip arthroplasty (HA) coating skillet femoral prosthesis, with the greater trochanter fixed using wire or steel when necessary. Patients’ Harris scores pre- and post-treatment, SF-36 Health Questionnaire score and digital radiology (DR) were used for joint prostheses initial stability and survival evaluation.Results15 patients completed follow-up periods ranging between 19 and 54 months (mean 26.2 months; 1 patient died from a pulmonary embolism, 1 patient died from pulmonary heart disease 1 year after surgery and 1 patient withdrew for personal reasons). There were no joint infections, periprosthetic fractures or dislocations. The average Harris score increased significantly, from 32.68 ± 12.04 points before surgery to 91.08 ± 5.9 points at 24 months post-treatment. SF-36 scores were significantly increased.ConclusionTHA as salvage treatment for failed internal fixation of intertrochanteric femoral fractures in elderly patients significantly reduced hip pain and restored joint function, and early clinical outcomes were satisfactory.
Highlights
Intertrochanteric fracture is a common fracture suffered by elderly patients
One patient died 1 month after surgery as a result of an acute pulmonary embolism. Another patient was found to have a deep vein thrombosis 3 months after surgery, which was improved after treatment. 16 patients without serious medical issues were discharged after their wounds had healed
social function (SF)-36 Health Questionnaire scores suggested that total hip replacement surgery could significantly lower risk of hip pain, promote hip functional recovery and improve overall health and quality of life (Table 3)
Summary
Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fixation failure, which remains somewhat controversial due to some clinical potential issues. Intertrochanteric fracture is one of the most common fractures suffered by elderly patients, and its incidence has been increasing yearly [1, 2]. Total hip arthroplasty (THA) is generally regarded as a salvage operation to restore hip joint function as early as possible after fixation failure [10,11,12,13] In this context, THA remains somewhat controversial due to potential problems including scar adhesion, blood loss, osteotomy plane angle, partial bone defect, postoperative soft tissue balance, offset reconstruction and postsurgical complications. We describe THA salvage treatment of 18 elderly patients suffering intertrochanteric fracture fixation failure, with positive clinical outcomes
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