Mid-term outcome of total hip arthroplasty for failed internal fixation of intertrochanteric fracture / 中华创伤杂志

ABSTRACT

Objective To evaluate the mid-term effect of total hip arthroplasty (THA) after failed internal fixation of intertrochanteric fracture.Methods Twenty-one patients treated with THA due to failed internal fixation of intertrochanteric fracture from January 2007 to December 2010 were studied retrospectively.There were 10 males and 11 females,at mean age of 71.7 years (range,66-79 years).Sixteen patients were treated with dynamic hip screws/dynamic condyle screws (DHS/DCS),3 proximal femoral nails,2 hollow screws.Mean interval from internal fixation to THA was 29 months (range,10-79 months).Causes for the failed internal fixation were loosening,cutting,and breakage of screws which generated fracture displacement or nonunion in 19 patients and femoral head necrosis in 2 patients.All patients received THA with uncemented acetabulum cups and proximally long-stemmed,porous-coated titanium femoral components including AML stems for 5 patients and Solution stems for 16 patients.Moreover,greater trochanteric fracture was fixed by Luke wire.Harris hip score were measured before operation and at final follow-up.Radiographs were performed before operation,at 3,6 and 12 months after operation,and at final follow-up to assess the fracture restoration,healing,prosthesis initial fixation,and mid-term survival condition.Results One patient was died due to pulmonary infection 1.5 years after operation.Two patients were lost to follow-up and 18 patients were followed up for 3-5 years (mean,3.9 years).At final follow-up,13 patients regained the ability to walk independently,4 needed support of a cane,1 needed assistance of a walker.There were no signs of loosening,subsidence or rupture of the prosthesis.Mean Harris hip score increased from 25.3 points preoperatively to 80.6 points at final follow-up; the score was excellent in 11 patients,good in 6,good in 1,with the excellent and good rate of 94％.Conclusion THA can improve hip function,patients' quality of life and midterm outcome in salvage of failed internal fixation of intertrochanteric fractures.