Hip Replacement after Proximal Femur Failed Osteosynthesis: our experience

Nicola Corradi; Gaetano Caruso; Ilaria Martini; Leo Massari

doi:10.23750/abm.v93i1.10853

Hip Replacement after Proximal Femur Failed Osteosynthesis: our experience

Authors

Nicola Corradi a:1:{s:5:"en_US";s:22:"Università di Ferrara";} https://orcid.org/0000-0001-8056-7493
Gaetano Caruso Department of Orthopaedic and Traumatology, University of Ferrara, Ferrara, Italy
Ilaria Martini Department of Orthopaedic and Traumatology, University of Ferrara, Ferrara, Italy https://orcid.org/0000-0003-1393-1421
Leo Massari Department of Orthopaedic and Traumatology, University of Ferrara, Ferrara, Italy

DOI: https://doi.org/10.23750/abm.v93i1.10853

Keywords:

proximal femur fracture, failure fixation, salvage hip arthroplasty, complications

Abstract

Background and aim: failure of proximal femur fixation is a rare but challenging complication. Hip replacement could be a safe and optimal salvage treatment option. However, serious complications could occur. The aim of our study is to retrospectively review all hip replacement performed after proximal femur fixation failure and to evaluate functional and radiographic outcomes.

Methods: we reviewed all Total Hip Arthroplasty and Hemiarthroplasty performed from 2013 to 2020 in Our Departement. We evaluated latest follow-up x-rays for stem subsidence, varus-valgus stem position (>5°), limb lenght inequality (>1cm), dislocation, component loosening, heterotopic calcification classified according to Brooker, cement leakage. Harris Hip Score (HHS) and Hip WOMAC score were perfomed at the latest follow-up to estimate functional outcome.

Results: 14 THA had no complications with mean HHS 86.5 and WOMAC score 91,68. 1 periprosthetic infection was reported on THA, however after 2-stages revision functional and radiographic otucomes were satisfactory. 5 HA had rated mean HHS 65.8 and WOMAC score 70.18. 2 HA experienced dislocations which required surgical revision and conversion to THA.

Conclusions: as a salvage surgery for failure of proximal femur fixation, Hip Replacement is safe and recommendable. THA reported better results than HA. Nonetheless, every patient should be carefully evaluated before undergoing surgery to detect possible complication risk factors

References

1. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996 Jan;18(1 Suppl):57S-63S.
2. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop Relat Res. 1990 Mar;(252):163-6..
3. Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA. Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol. 1996 Apr 1;143(7):677-82.
4. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018 Aug;49(8):1458-1460.
5. Fernandez MA, Griffin XL, Costa ML. Management of hip fracture. Br Med Bull. 2015 Sep;115(1):165-72.
6. Pincus D, Ravi B, Wasserstein D, et al. Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery. JAMA. 2017;318(20):1994–2003.
7. Evaniew N, Bhandari M. Cochrane in CORR ®: Intramedullary nails for extracapsular hip fractures in adults (review). Clin Orthop Relat Res. 2015;473(3):767–774.
8. Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J. 2017;99-B(1):128–133.
9. Lu Y, Uppal HS. Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation. Geriatr Orthop Surg Rehabil. 2019;10:2151459319859139.
10. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121–129.
11. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;(4):CD001708.
12. Dix DB, Araoye IB, Staggers JR, et al. A systematic review and meta-analysis of complications in conversion arthroplasty methods for failed intertrochanteric fracture fixation. J Clin Orthop Trauma. 2019;10(2):282–285.
13. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973 Dec;55(8):1629-32
14. Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury. 2013;44(6):735–742.
15. Brunner A, Büttler M, Lehmann U, et al. What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?: A multicentre study. Injury. 2016;47(2):432-438.
16. Morice A, Ducellier F, Bizot P; Orthopaedics and Traumatology Society of Western France (SOO). Total hip arthroplasty after failed fixation of a proximal femur fracture: Analysis of 59 cases of intra- and extra-capsular fractures. Orthop Traumatol Surg Res. 2018;104(5):681–686.
17. Krause PC, Braud JL, Whatley JM. Total hip arthroplasty after previous fracture surgery. Orthop Clin North Am. 2015;46(2):193–213.
18. Mortazavi SM, R Greenky M, Bican O, Kane P, Parvizi J, Hozack WJ. Total hip arthroplasty after prior surgical treatment of hip fracture is it always challenging?. J Arthroplasty. 2012;27(1):31–36.
19. Luthringer TA, Elbuluk AM, Behery OA, Cizmic Z, Deshmukh AJ. Salvage of failed internal fixation of intertrochanteric hip fractures: clinical and functional outcomes of total hip arthroplasty versus hemiarthroplasty. Arthroplast Today. 2018;4(3):383–391..
20. Boulat S, Neri T, Boyer B, Philippot R, Farizon F. Dual mobility cups in total hip arthroplasty after failed internal fixation of proximal femoral fractures. Orthop Traumatol Surg Res. 2019;105(3):491–495.
21. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr. Total hip arthroplasty after failed internal fixation of proximal femoral fractures. J Arthroplasty. 2013;28(1):168–171.
22. Angelini M, McKee MD, Waddell JP, Haidukewych G, Schemitsch EH. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009;23(6):471–478.
23. Chen DW, Lin CL, Hu CC, Tsai MF, Lee MS. Biomechanical consideration of total hip arthroplasty following failed fixation of femoral intertrochanteric fractures - a finite element analysis. Med Eng Phys. 2013;35(5):569–575
24. Smith A, Denehy K, Ong KL, Lau E, Hagan D, Malkani A. Total hip arthroplasty following failed intertrochanteric hip fracture fixation treated with a cephalomedullary nail. Bone Joint J. 2019;101-B(6_Supple_B):91–96.
25. Mahmoud SS, Pearse EO, Smith TO, Hing CB. Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis. Bone Joint J. 2016;98-B(4):452–460.
26. DeHaan AM, Groat T, Priddy M, et al. Salvage hip arthroplasty after failed fixation of proximal femur fractures. J Arthroplasty. 2013;28(5):855–859.
27. Neri T, Philippot R, Klasan A, et al. Dual mobility acetabular cups for total hip arthroplasty: advantages and drawbacks. Expert Rev Med Devices. 2018;15(11):835–845
28. D'Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop. 2010;34(7):939–942.
29. Tetsunaga T, Fujiwara K, Endo H, et al. Total hip arthroplasty after failed treatment of proximal femur fracture. Arch Orthop Trauma Surg. 2017;137(3):417–424.
30. Lachiewicz PF, Kleeman LT, Seyler T. Bearing Surfaces for Total Hip Arthroplasty. J Am Acad Orthop Surg. 2018;26(2):45–57.
31. Zagra L, Gallazzi E. Bearing surfaces in primary total hip arthroplasty. EFORT Open Rev. 2018;3(5):217–224..
32. Müller F, Galler M, Zellner M, Bäuml C, Füchtmeier B. Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients. J Orthop Surg (Hong Kong). 2017;25(2):2309499017717869.
33. Winemaker M, Gamble P, Petruccelli D, Kaspar S, de Beer J. Short-term outcomes of total hip arthroplasty after complications of open reduction internal fixation for hip fracture. J Arthroplasty. 2006;21(5):682–688.