scholarly journals 854 Mortality Associated with Conversion of Total Hip Arthroplasty for Failed Fixation/Hemiarthroplasty for Neck of Femur Fractures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
W Khan ◽  
A Baig ◽  
Q Afzaal ◽  
J Davison ◽  
S Hutchings ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Posttraumatic Arthritis ◽  
Time To Failure ◽  
Neck Of Femur ◽  
Total Hip ◽  
Femur Fractures ◽  
The Mean

Abstract Aim To identify the mortality associated with failed internal fixation and hemiarthroplasty of neck of femur fractures. Method Patients undergoing conversion of internal fixation / hemi arthroplasty were identified from theatre records and surgical databases. Data was stored in Microsoft Excel spreadsheet. Clinical outcomes at 30 days, 1 year and 5 years post conversion total hip replacement. Results 60 cases were collected between June 2006 and November 2016. 46 females and 14 males involved in the case. The mean age of male patients was 66.5 and for females 67.9. 32 patients had previous sliding hip screw fixation,12 had intra-medullary nails, 8 had cannulated screw fixation and 5 patients had hemiarthroplasty. The mean time to failure was 22 months (Range: 2 weeks to 60 months) and there were 6 cases of late posttraumatic arthritis (range 4 yrs to 23 yrs). Average time from documented failure to conversion THR was 2 months. There were 2 superficial wound infections which were successfully treated with antibiotics. There were 2 cases of deep infection which required multiple debridement, washout, and prolonged inpatient stay. Average duration of hospital stay was 5.7days. 18 patients died before 5 years for reasons unrelated to their hip. All had a functional prosthesis at time of last review. 42 patients alive at 5 years had a functional prosthesis at last review Conclusions Total Hip Arthroplasty is a successful procedure for failed fixation / hemiarthroplasty despite the technical challenges. A 3–5-year mortality rate of 33.33 % reflects well against the NHFD 1year mortality of 30 %.

scholarly journals Dual mobility total hip arthroplasty for salvaging failed internal fixation for neck of femur fractures

2020 ◽  
Vol 27 (1) ◽  
pp. 68-71
Author(s):  
Jatinder Singh Luthra ◽  
Suwailim Al Ghannami ◽  
Salim Al Habsi ◽  
Soubhik Ghosh
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Neck Of Femur ◽  
Dual Mobility ◽  
Wound Debridement ◽  
Total Hip ◽  
Femur Fractures

Internal fixation is commonly used to treat fractures in the hip. However, failure of proximal femoral fracture fixation is common and treated with total hip replacement (THR). The aim of this study is to present our midterm results of dual mobility (DM) THR for failed internal fixation of proximal femur fractures. Between 2010 and 2015, a total of 28 cases of failed internal fixation for hip fractures were treated through DM total hip arthroplasty. Two patients died during the early postoperative period due to medical complications. The average follow-up was 3.4 years. We had one patient with superficial surgical site infection which was managed by local wound debridement and dressings. The average Harris hip score was 85. DM THR is the procedure of choice for revising failed internal fixation for hip fractures in our patients with good clinical outcome.

scholarly journals Analysis of total hip arthroplasty for displaced intracapsular neck of femur fractures in a tertiary referral trauma centre

Injury Extra ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 105
Author(s):  
Z. Gamie ◽  
J. Neale ◽  
D. Shields ◽  
J. Claydon ◽  
S. Hazarika ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Trauma Centre ◽  
Tertiary Referral ◽  
Neck Of Femur ◽  
Total Hip ◽  
Femur Fractures

Treatment of displaced intracapsular fractures of the femoral neck with total hip arthroplasty or hemiarthroplasty

2020 ◽  
Vol 102-B (6) ◽  
pp. 693-698 ◽  
Author(s):  
Aparna Viswanath ◽  
Anum Malik ◽  
Warwick Chan ◽  
Antonio Klasan ◽  
Neil P. Walton
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Radical Change ◽  
Neck Of Femur ◽  
Trochanteric Bursitis ◽  
Total Hip ◽  
Femur Fractures ◽  
Change In Practice ◽  
The Subject

Aims Despite few good-quality studies on the subject, total hip arthroplasty (THA) is increasingly being performed for displaced intracapsular fractures of the neck of femur. We compared outcomes of all patients with displacement of these fractures treated surgically over a ten-year period in one institution. Methods A total of 2,721 patients with intracapsular fractures of the femoral neck treated with either a cemented hemiarthroplasty or a THA at a single centre were retrospectively reviewed. The primary outcomes analyzed were readmission for any reason and revision surgery. We secondarily looked at mortality rates. Results We found no difference in the overall revision rate or rate of infection. However, the rates of readmission due to dislocation, pain, and trochanteric bursitis were significantly higher in the THA group (p = 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). Conclusion Our study, comparing the outcomes of neck of femur fractures treated with a cemented hemiarthroplasty and THA, revealed the perceived superiority of THA was not borne out by our results. This should be carefully considered before any radical change in practice regarding the use of THA for displaced intracapsular fractures of the femoral neck. Cite this article: Bone Joint J 2020;102-B(6):693–698.

scholarly journals Role of Biplane Double Supported Screw Fixation For Fracture Neck Femur In Elderly Population: A Prospective Study

2018 ◽  
Vol 12 (1) ◽  
pp. 514-524
Author(s):  
Anoop Kalia ◽  
Jagdeep Singh ◽  
Nasir Ali
Keyword(s):  
Total Hip Arthroplasty ◽  
Prospective Study ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Harris Hip Score ◽  
Total Hip ◽  
Fracture Neck Femur ◽  
The Mean ◽  
A Prospective Study

Introduction: The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture. Various treatment options available for elderly are screw fixation, hemiarthroplasty and total hip arthroplasty. Materials and Methods: This is a prospective study done at authors institutes between January 2014- December 2016. 30 patients aged more than 50 years who sustained fracture neck femur were included in the study. 3 patients were lost to follow up and 2 patients died due to medical comorbidities. Out of the 25 remaining patients, 17 were males and 8 were females and they were operated by the biplane double supported screw fixation method (BDSF TECHNIQUE) and were followed up for a period of two years. The final Harris Hip Score at the last follow up was calculated. Results: Out of the 25 patients, the union was achieved in all the patients. The mean duration of union was 10 weeks. 1 patient had progressive femoral head resorption due to chondrolysis resulting in antalgic gait and unbearable pain and underwent total hip arthroplasty. The mean harris hip score was 81.2 Conclusion: In elderly patients with osteoporosis and in those patients who can not afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for fixing fracture neck femur.

scholarly journals Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

2021 ◽  
Author(s):  
P. Hemmann ◽  
F. Schmidutz ◽  
M. D. Ahrend ◽  
S. G. Yan ◽  
U. Stöckle ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Low Grade ◽  
Complication Rates ◽  
Total Hip ◽  
Femur Fractures ◽  
Increased Risk

Abstract Background Higher complication rates have been reported for total hip arthroplasty (THA) after osteosynthesis of proximal femur fractures (PFF). This study evaluated the infection risk for conversion of internal fixation of PFF to THA by a single-staged procedure in the absence of clear infection signs. Methods Patients undergoing a one-staged conversion to THA (2013–2018) after prior internal fixation of the proximal femur were included. Preoperative diagnostics with laboratory results, hip aspirations as well as intraoperative microbiology and sonication were assessed. Postoperative complications were recorded as well as patient demographics, duration between initial and conversion to THA, explanted osteosynthesis and implanted THA. Results Fifty-eight patients (24 male/34 female, 62.8 ± 14.5 years) were included with a mean time of 3.8 ± 7.5 years between internal fixation and conversion to THA (45 cementless, 3 cemented, 3 hybrid and 7 hybrid inverse THAs). Preoperative mean blood level CRP was 8.36 ± 14 mg/l (reference value < 5 mg/l) and leukocyte count was 7.11 ± 1.84^3/µl (4.5–10.000^3/µl). Fifty patients had intraoperative microbiological diagnostics, with either swabs in 86.2% and/or sonication in 29.3%. Positive microbiological results were recorded in 10% (5 of 50 patients), with pathogens identified being mainly Staphylococcus. Complications after conversion occurred in 9.6% including a postoperative low-grade infection rate of 5.8% after a mean of 2.5 years. Conclusion This study found a positive microbiological test result in 10% of a one-stage conversion of PFF fixation to THA. Moreover, we found a high infection rate (5.8%) for early postoperative periprosthetic joint infection. Interestingly, CRP has not been proven to be an adequate parameter for low-grade infections or occult colonized implants. Therefore, we recommend a comprehensive pre- and intraoperative diagnostic including hip aspiration, swabs and sonication when considering one-staged revision.

scholarly journals Cementless total hip arthroplasty after failed internal fixation of acetabular fractures: A single center experience of 25 consecutive patients

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091066
Author(s):  
Min Uk Do ◽  
Won Chul Shin ◽  
Nam Hoon Moon ◽  
Suk-Woong Kang ◽  
Kuen Tak Suh
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Acetabular Fractures ◽  
Walking Ability ◽  
Total Hip ◽  
The Mean

Purpose: Total hip arthroplasty (THA) is an available surgical option for failed acetabular fracture, previously managed by open reduction and internal fixation. This study aimed to report the postoperative outcomes of cementless THA in patients with this condition. Materials and Methods: Between November 2000 and September 2016, 25 consecutive cementless THAs for failed internal fixation after acetabular fractures with a minimum follow-up of 2 years were analyzed. The mean age at the time of surgery was 58 years (36–85 years), and the time elapsed between fracture and THA was 70 months (7–213 months). Clinical and radiologic evaluations were performed on all patients. Results: Clinically, the mean Harris hip score at the last follow-up was 88 points. Walking ability recovered to pre-injury status in 92% patients, and activities of daily living recovered in 96% patients. Radiographically, none of the acetabular cups showed evidence of migration and loosening during the mean follow-up of 50 months. All cases showed stable femoral stem fixation at the last follow-up. Dislocation occurred in three cases (12%). Conclusion: Outcomes of cementless THA after failed internal fixation for acetabular fractures were satisfactory. However, a relatively high incidence of postoperative dislocation is still a concern.

scholarly journals Custom Cementless Femoral Stems in Total Hip Arthroplasty

2019 ◽  
Vol 03 (02) ◽  
pp. 068-072
Author(s):  
Glenn D. Wera ◽  
Mark W. Dwyer ◽  
Daniel R. Verhotz ◽  
Matthew A. Popa ◽  
Randall E. Marcus
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Long Term Results ◽  
Complication Rates ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
Femur Fractures ◽  
Femoral Stems ◽  
The Mean

AbstractObtaining appropriate prosthetic fit in cementless total hip arthroplasty can be challenging in cases with disparity between the femoral and metaphyseal diameters of the femur or cases of complex deformity. One solution has been to utilize a custom femoral component in total hip arthroplasty. The long-term results of this option with respect to femoral morphology are limited. This cohort was analyzed to determine the survivorship, functional results using Harris Hip Scores (HHSs), and complication rates using these implants. Survivorship and complications were evaluated based on the proximal femoral anatomy and severity of arthritis. The authors retrospectively reviewed 73 cases of custom femoral implants in total hip arthroplasties by a single surgeon. The average age of patients at index surgery was 58.06 years (range, 36.00–73.75 years). The mean follow-up was 8.59 years (range, 0.17–20.33 years) with a minimum of 2-year follow-up required for analysis of HHS data. There were 8 failures at a mean of 67.68 months (range, 2.04–135 months). The reasons for revision were infection (2), osteolysis (1), periprosthetic fracture (3), osteolysis and aseptic loosening (1), and polyethylene wear (1). The mean preoperative HHS was 55.38 (range, 31–90). The mean follow-up HHS was 93.10 (range, 38–100) with a mean improvement of 37.44 (p < 0.0001). Complications included infection (3), fracture (6), and dislocation (3). Preoperative Dorr classification A (n = 44), B (n = 24), and C (n = 1) and Kellgren–Lawrence grades I (n = 0), II (n = 2), III (n = 7), and IV (n = 60) were not predictive of failure or revision (p = 0.45, p = 0.6). There was a near significant association between Dorr classification B femur fractures requiring revision (p < 0.053). Kaplan–Meier predicted survivorship was 20.33 years with revision for any reason as the endpoint and total overall survivorship of 81.7%. Custom cementless femoral stems provide satisfactory survivorship and improvement in hip scores in a variety of patients undergoing cementless total hip arthroplasty. Fracture rates are higher in Dorr class B femurs. The level of evidence was IV.

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