ABSTRACT
OBJECTIVES: Although literature exists regarding surgery after hip screw/side plate devices, we are unaware of any reports of hip arthroplasty after intramedullary devices. DESIGN: This is a retrospectively reviewed case series. SETTING: Tertiary care medical center. PATIENTS/PARTICIPANTS: A consecutive unselected series. INTERVENTION: Hip arthroplasty surgery after failed hip fracture fixation surgery using an intramedullary nail device. MAIN OUTCOME MEASUREMENTS: Twenty cases of conversion surgery after intramedullary fixation for hip fractures were retrospectively reviewed. RESULTS: The indications for hip arthroplasty were nonunion with failed fixation in 15, avascular necrosis with secondary hip arthritis in three, and progression of hip arthritis in four. Average operative time and blood loss were 166 minutes and 621 mL, respectively. Of note, nine of 20 patients ultimately developed a nonunion of the greater trochanter after hip arthroplasty. In only one of these cases of nonunion was the greater trochanter refractured intraoperatively and this as part of a trochanteric osteotomy. CONCLUSION: Patients undergoing hip arthroplasty after failed hip fracture fixation using an intramedullary nail device are at high risk for greater trochanteric fracture and nonunion. The average operative time and blood loss for these procedures were greater than reported for primary but less than for revision arthroplasty. We now consider treating these cases with a trochanteric plate with or without a trochanteric slide osteotomy to minimize fracture of the remaining, damaged trochanteric bone. LEVEL OF EVIDENCE: Therapeutic Level IV. See page 128 for a complete description of levels of evidence.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Bone Screws/adverse effects , Fracture Fixation, Intramedullary/adverse effects , Limb Salvage/methods , Prosthesis Failure , Aged , Aged, 80 and over , Female , Hip Fractures/surgery , Hip Joint/physiopathology , Hip Joint/surgery , Humans , Male , Middle Aged , Perioperative Period , Retrospective StudiesABSTRACT
BACKGROUND: Increasingly, acetabular retroversion is recognized in patients undergoing hip arthroplasty. Although prosthetic component positioning is not determined solely by native acetabular anatomy, acetabular retroversion presents a dilemma for component positioning if the surgeon implants the device in the anatomic position. QUESTIONS/PURPOSES: We asked (1) whether there is a difference in ROM between surface replacement arthroplasty (SRA) and THA in the retroverted acetabulum, and (2) does increased femoral anteversion improve ROM in the retroverted acetabulum? METHODS: Using a motion analysis tracking system, we determined the ROM of eight cadaveric hips and then created virtual CT-reconstructed bone models of each specimen. ROM was determined with THA and SRA systems virtually implanted with (1) the acetabular component placed in 45° abduction and matching the acetabular anteversion (average 23° ± 4°); (2) virtually retroverting the bony acetabulum 10°; and (3) after anteverting the THA femoral stem 10°. RESULTS: SRA resulted in ROM deficiencies in four of six maneuvers, averaging 25% to 29% in the normal and retroverted acetabular positions. THA restored ROM in all six positions in the normal acetabulum and in four of the six retroverted acetabula. The two deficient positions averaged 5% deficiency. THA with increased femoral stem anteversion restored ROM in five positions and showed only a 2% deficiency in the sixth position. Compared with the intact hip, ROM deficits were seen after SRA in the normal and retroverted acetabular positions and to a lesser extent for THA which can be improved with increased femoral stem anteversion. CONCLUSION: Poor ROM may result after SRA if acetabular retroversion is present.
