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Archives of Orthopaedic and Trauma Surgery

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01-03-2017 | Hip Arthroplasty

Total hip arthroplasty after failed treatment of proximal femur fracture

Authors: Tomonori Tetsunaga, Kazuo Fujiwara, Hirosuke Endo, Tomoyuki Noda, Tomoko Tetsunaga, Toru Sato, Naofumi Shiota, Toshifumi Ozaki

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2017

Abstract

Introduction

Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures.

Materials and methods

We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment.

Results

Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p < 0.0001). Postoperative complications in the trochanteric fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p < 0.0001 for both).

Conclusions

Performing THA after failed treatment of trochanteric fractures requires consideration of complication risk and incorrect femoral neck anteversion.

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Title: Total hip arthroplasty after failed treatment of proximal femur fracture
Authors: Tomonori Tetsunaga
Kazuo Fujiwara
Hirosuke Endo
Tomoyuki Noda
Tomoko Tetsunaga
Toru Sato
Naofumi Shiota
Toshifumi Ozaki
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-017-2631-0

At a glance: The STEP trials

Springer Medicine

Total hip arthroplasty after failed treatment of proximal femur fracture

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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