Total hip replacement the ideal joint for failed osteosynthesis of hip fractures

Abstract

Introduction: 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. Management of failed internal fixation of proximal hip fractures includes revision osteosynthesis or conversion total hip arthroplasty (THA). Total hip arthroplasty is generally accepted as the most successful salvage procedure for failure of these fixation devices. Conversion of failed hip surgeries to THA is indicated where the bone quality is poor, head is damaged due to previous internal fixation, poor bone stock, or limb shortening. Total hip arthroplasty in these patients may be difficult because of presence of previous implant, poor bone stock, scarred tissues and increased risk of infection. Aim: The aim of this study was to analyze the short-term followup of functional results of 31 uncemented total hip replacement surgeries for failed osteosynthesis of hip fractures prospectively. Materials and Methods: We had done 31 porous-coated uncemented total hip replacement surgeries in 29 patients for a variety of indications. The patients were reviewed regularly at 1 month interval for first 3 months, then at 6 months, 1 year and periodically thereafter for every 6 months. At the end of this study the patients were called back for review. Patients were reassessed clinically using the Harris hip score. X-rays of the hip were taken and were compared with the initial x-rays for signs of loosening, migration, wear and implant failure. Results: All patients were evaluated clinically and radiologically preoperatively and at various followup periods. In our study, 15 hips showed excellent results, 10 hips showed good results, 3 hips showed fair results and 3 hips showed poor results. In a study performed by Kim YH et al, Seventy-five hips (65%) were excellent, 11 (9%) were good, and 30 (39%) were poor. Conclusion: The uncemented total hip arthroplasty is the best choice of surgery for failed reconstructive surgeries of the proximal femur in individuals with good bone quality. As this is only a short term study, further follow-up and evaluation is essential to come out with a definitive conclusion.