Uncemented hip arthroplasty for failed internal fixation of peritrochanteric fracture

Abstract

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture. Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study. The patients aged 67.2 years(range, 41-80 years) composed 6 males and 11 females. There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture. The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients. Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation. Harris score was used for evaluation of the results of hip arthroplasty. Preoperative Harris score was (32.6±6.8)points. Results All the patients were followed up for 6 to 48 months. One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery. One patient had secondary subsidence of the femoral stem without pain and limitation of motion. One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation. Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening. Harris hip score significantly improved to (79.2±15.9)points at the final follow-up (P<0.01). Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture. The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability, and avoids the complications of bone cement use. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure