Hip Arthroplasty for failed internal fixation of intertrochanteric fractures.
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Published:
Feb 15, 2018
Keywords:
trochanterics fractures, DHS, failed internal fixation, hip arthroplasty.
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Abstract
IntroductionThe purpose of this retrospective study was to asses the clinical and radiographics outcomes, complications as well technicals problems of hip arthroplasty following failure of dynamic screw fixation of the intertrochanterics fractures.Methods38 hip arthroplasty in 38 patients were reviewed. There were 31 females and 7 males. The mean age was 75,59 (67-90) years and average follow – up was 45,5 (16-128) months. The prosthesis types included 30 total hip arthoplasties, 7 bipolar hip arthroplasties and one resection tumoral prothesis. Nine large femoral stems were used. Eleven uncemented cups and 20 cemented were used. We evaluated the presence of pain and objectively the Harris hip score (HSS) was used. Radiologically cementing quality, the appearance of a radiolucent line at the cement-stem interfase, the presence of loosening, nonunion of the greater trochanter and its complications was analyzed.ResultsAverage Harris Hip Score was 79 (70-88) points. 30 of 35 cemented femoral stems were rated as Barrack A, 4 as B and 1 as C. There were no revisions for aseptic loosening. There were 5 nonunion of greater trochanter, 3 acutes infections, and 3 dislocations, one of them need reoperation.ConclusionHip arthroplasty as salvage procedure after failed dynamic screw fixation is a satisfactory procedure with aceptable clinical outcomes and resumption of ambulation. This procedure is technically challenges with hight complications rate.
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How to Cite
Lopreite, F., Garabano, G., Pesciallo, C., & Del Sel, H. (2018). Hip Arthroplasty for failed internal fixation of intertrochanteric fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(1), 12-19. https://doi.org/10.15417/725
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Clinical Research
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References
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2- Kyle RF. Fractures of the proximal part of the femur. JBJS Am 1994;76:924-950.
3- Lopreite F, Ratto J, del Sel H. Fractura lateral de cadera. Análisis de fallas y complicaciones con el clavo compresivo dinámico. Rev AAOT 2005;70(4):307-312.
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5- Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. JBJS Am 2008;90:700-7.
6- Haidukewych GJ, Berry DJ. Hip artrhoplasty for salvataje of failed treatment of intertrochanteric hip fractures. JBJS Am 2003;85:899-905.
7- Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity of fractures of the intertrochanteric region of the femur. JBJS Am 2001;83:643-650.
8- Im GI, Shin YW, Song YJ. Potentiallity unstable intertrochanteric fractures. Journ Orthop Trauma 2005;19:5-9.
9- Madsen JE, Naess L, Aune AK, Stromsoe K. Dynamic Hip Screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with Gamma nail and compression hip screw. Journ Orthop Trauma 1998;12:241-8.
10- Alvarez DB, Aparicio JP, Fernandez EL, Jimenez JP. Implant breakage, a rare complication with Gamma nail. A review of 843 fractures of the proximal femur treated with Gamma nail. Acta Orthop Belg 2004;70:435-443.
11- Haidukewych GJ, Berry DJ. Salvatage of failed internal fixation of intertrochanteric hip fractures. Clin Orthop 2003;412:184-8.
12- Said GZ, Farouk O, El-Sayed A, Said H. Salvatage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury 2006;37:194-202.
13- Stoffelen D, Haentjens P, Reynders P, Opdecam P y cols. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fracturesin the elderly patient. Acta Orthop Belg 1994;60(Suppl 1):135-9.
14- Kligman M, Roffman M. Conversion total hip replacement after failed internal fixation of intertrochanteric fracture. Harefuah 1998;134:690-92.
15- Zhang B, Chiu KY, Wang M. Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplasty 2004;19:329-333.
16- D’Arrigo C, Perugia D, Carcangiu A, Monaco E, Ferreti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthropaedics 2010;34:939-942.
17- Evans EM. The treatment of trochanteric fractures of the femur. JBJS Br 1949;31:190-205.
18- Harris WH. Traumatic arthritis of the hip after dislocation and
acetabular fracture: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. JBJS Am 1969;51:737-40.
19- Barrack RL, Mulroy RD, Harris WH. Improved cementing techniques and femoral component loosening in Young patients with hip arthroplasty. A 12-year radiographic review. JBJS Br 1992;74:385-89.
20- Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 1979;141:17-27.
21- DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;121:20-25.
22- Hodgkinson JP, Shelly P, Wrobleski BM. The correlation between roentgenographics appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasty. Clin Orthop1988;228:105-9.
23- Harris WH, McCarthy JC, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. JBJS Am 1982;64:1063-8.
24- Engh CA, Glassman AH, Suthers KE. The case forporus-coated hip implants. The femoral side. Clin Orthop 1990;261-90-8.
25- Brooker AF, Bowerman JW, Robinson RA y cols. Ectopic ossification following total hip replacement. Incidence a method of classification. JBJS Am 1973;55:1629-32.
26- Haidukewych GJ, Berry DJ. Salvaje of failed treatment of hip fractures. J Am Acad Orthop Surg 2005;13:101-109.
27- Unnanuntana A, Goodman SB. Conversion total hip replacement after malunited intertrochanteric fracture: a technical note. Am J Orthop 2008;37(10):506-509.
28- Patterson BM, Salvati EA, Huo MH. Total hip arthropasty for complications of intertrochanteric fracture. A technical note. JBJS Am 1990;72:776-777.
29- Laffosse JM, Molinier F, Tricoire JL, Bonnevialle N, Chiron P, Puget J. Cementless modular hip arthroplasty as a salvataje operation for failed internal fixation of trochanteric fractures in elderly patients. Acta Orthop Belg 2007;73:729-736.
30- Abouelela AKH. Salvatage of failed trochanteric fracture fixation using the revitan curved cementless modular hip arthroplasty. Journ Arthop 2012;27(7):1382-1388.
31- Burstein AH, Currey J, Frankel VH y cols. The effect of screw holes. JBJS Am 1972;54:1143-8.
32- Edgerton BC, An KN, Morrey BF. Torsional strength reduction due to cortical defects in bone. Journ Orthop Res Am 1990;8:851-7.
33- Hammad A, Abdel AAL, Said HG, Bakr H. Total hip arthroplasty following failure of dynamic hip screw fixation of fractures of the proximal femur. Acta Orthop Belg 2008;74:788-792.
34- Hsieh PH, Chang YH, Chen SH, Shih CH. Staged arthroplasty as salvataje procedure for deep hip infection following intertrochanteric fracture. Int Orthop 2006;30(4):228-232.
2- Kyle RF. Fractures of the proximal part of the femur. JBJS Am 1994;76:924-950.
3- Lopreite F, Ratto J, del Sel H. Fractura lateral de cadera. Análisis de fallas y complicaciones con el clavo compresivo dinámico. Rev AAOT 2005;70(4):307-312.
4- Gonzalez GA. Salvataje de fallas en fracturas laterales de cadera tratadas con fijación interna. Tratamiento y resultados funcionales. Rev AAOT 2006;71(3):232-236.
5- Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. JBJS Am 2008;90:700-7.
6- Haidukewych GJ, Berry DJ. Hip artrhoplasty for salvataje of failed treatment of intertrochanteric hip fractures. JBJS Am 2003;85:899-905.
7- Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity of fractures of the intertrochanteric region of the femur. JBJS Am 2001;83:643-650.
8- Im GI, Shin YW, Song YJ. Potentiallity unstable intertrochanteric fractures. Journ Orthop Trauma 2005;19:5-9.
9- Madsen JE, Naess L, Aune AK, Stromsoe K. Dynamic Hip Screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with Gamma nail and compression hip screw. Journ Orthop Trauma 1998;12:241-8.
10- Alvarez DB, Aparicio JP, Fernandez EL, Jimenez JP. Implant breakage, a rare complication with Gamma nail. A review of 843 fractures of the proximal femur treated with Gamma nail. Acta Orthop Belg 2004;70:435-443.
11- Haidukewych GJ, Berry DJ. Salvatage of failed internal fixation of intertrochanteric hip fractures. Clin Orthop 2003;412:184-8.
12- Said GZ, Farouk O, El-Sayed A, Said H. Salvatage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury 2006;37:194-202.
13- Stoffelen D, Haentjens P, Reynders P, Opdecam P y cols. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fracturesin the elderly patient. Acta Orthop Belg 1994;60(Suppl 1):135-9.
14- Kligman M, Roffman M. Conversion total hip replacement after failed internal fixation of intertrochanteric fracture. Harefuah 1998;134:690-92.
15- Zhang B, Chiu KY, Wang M. Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplasty 2004;19:329-333.
16- D’Arrigo C, Perugia D, Carcangiu A, Monaco E, Ferreti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthropaedics 2010;34:939-942.
17- Evans EM. The treatment of trochanteric fractures of the femur. JBJS Br 1949;31:190-205.
18- Harris WH. Traumatic arthritis of the hip after dislocation and
acetabular fracture: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. JBJS Am 1969;51:737-40.
19- Barrack RL, Mulroy RD, Harris WH. Improved cementing techniques and femoral component loosening in Young patients with hip arthroplasty. A 12-year radiographic review. JBJS Br 1992;74:385-89.
20- Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 1979;141:17-27.
21- DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;121:20-25.
22- Hodgkinson JP, Shelly P, Wrobleski BM. The correlation between roentgenographics appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasty. Clin Orthop1988;228:105-9.
23- Harris WH, McCarthy JC, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. JBJS Am 1982;64:1063-8.
24- Engh CA, Glassman AH, Suthers KE. The case forporus-coated hip implants. The femoral side. Clin Orthop 1990;261-90-8.
25- Brooker AF, Bowerman JW, Robinson RA y cols. Ectopic ossification following total hip replacement. Incidence a method of classification. JBJS Am 1973;55:1629-32.
26- Haidukewych GJ, Berry DJ. Salvaje of failed treatment of hip fractures. J Am Acad Orthop Surg 2005;13:101-109.
27- Unnanuntana A, Goodman SB. Conversion total hip replacement after malunited intertrochanteric fracture: a technical note. Am J Orthop 2008;37(10):506-509.
28- Patterson BM, Salvati EA, Huo MH. Total hip arthropasty for complications of intertrochanteric fracture. A technical note. JBJS Am 1990;72:776-777.
29- Laffosse JM, Molinier F, Tricoire JL, Bonnevialle N, Chiron P, Puget J. Cementless modular hip arthroplasty as a salvataje operation for failed internal fixation of trochanteric fractures in elderly patients. Acta Orthop Belg 2007;73:729-736.
30- Abouelela AKH. Salvatage of failed trochanteric fracture fixation using the revitan curved cementless modular hip arthroplasty. Journ Arthop 2012;27(7):1382-1388.
31- Burstein AH, Currey J, Frankel VH y cols. The effect of screw holes. JBJS Am 1972;54:1143-8.
32- Edgerton BC, An KN, Morrey BF. Torsional strength reduction due to cortical defects in bone. Journ Orthop Res Am 1990;8:851-7.
33- Hammad A, Abdel AAL, Said HG, Bakr H. Total hip arthroplasty following failure of dynamic hip screw fixation of fractures of the proximal femur. Acta Orthop Belg 2008;74:788-792.
34- Hsieh PH, Chang YH, Chen SH, Shih CH. Staged arthroplasty as salvataje procedure for deep hip infection following intertrochanteric fracture. Int Orthop 2006;30(4):228-232.