- 期刊
Conversion HIP Arthroplasty after Failed Fixation of Proximal HIP Fracture
並列摘要
A retrospective analysis of 23 conversion hip arthroplasties following failed osteosynthesis of femoral neck or intertrochanteric fractures between January 1984 and September 1994 was performed. The mean patient age was 61 years with a mean follow up period of 49 months. Fifteen patient (65%) sustained femoral neck fractures. Eight of these fifteen were treated with multiple lag screws and the remaining seven with a comprssion hip screw. Eight patients (35%) sustained intertrochanteric fractures and were treated with compression hip screw. In accordance with the underlying pathology leading to arthroplasty, twelve patients (52%) with united fracture required hip arthroplasty due to avascular necrosis (AVN) or osteoarthritis (OA) and eleven patients (48%) underwent arthroplasty for nonunion. The overall clinical results usijng the modified Harris hip score revealed mean 42 preoperatively and mean 86 postoperatively. There were five significant complications in this series: one hip dislocation, one deep infection,, two superficial infection, and one trochanteric avulsion fracture through a previous lag screw hole. Half of the failed intertrochanteric fracture patients in this serises presented with both trochanteric and shaft nonunions with lag screw extrusion through the femoral head. One subject had only a greater trochanteric nonunion. Both deformity and nonunion of the proximal femur increased the difficulty of the operative procedure necessitating a trochanteric osteotomy and/or a calcar replacement femoral component. The clinical results were found to be independent of the different fixation methods used for initial fixation in the femoral neck fractures. Less satisfactory clinical scores were obtained in the intertrochanteric group than the femoral neck group. While hip arthroplasty was found to be an effective salvage procedure after failed internal fixation of proximal hip fractures, these procedures may be more complex than the routine primary hip arthroplasty. Preoperative planning is critical. Surgical alternatives may include the use of a trochanteric osteotomy, non-standard femoral components, and allograft bone. Infection is another potential problem encounted. Both negative preoperative culture and no evidence of infection on intraoperative frozen sections prior to arthroplasty are suggested.