Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting.

BACKGROUND: Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients. MATERIALS AND METHODS: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA. All ten patients returned for interviews and clinical examination. The average time for clinical followup was 35 months (range 5-48 months). The mean age of the study cohort was 65 years (range 56-74 years). Time to union and incidence of postoperative complications were assessed. RESULTS: Union occurred in all ten cases at an average of 3.3 months postoperatively. One patient developed symptomatic trochanteric bursitis and required plate removal. Another patient developed a superficial infection which was successfully treated with local wound debridement and antibiotics. A third patient developed a symptomatic neuroma at the site of the iliac crest bone harvest and was successfully treated with excision of the neuroma. No catastrophic implant failures occurred. CONCLUSIONS: The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

Demographic factors affecting long-term outcome of total hip arthroplasty.

We report the outcome of total hip arthroplasty (THA) in a cohort of patients with complete long-term radiographic and clinical followup information from our database of more than 48,000 primary hip replacements. The purpose of the study was to evaluate the influence of various demographic factors and patient comorbidity (Charnley classification) on the long-term outcome of THA. The cohort was comprised of 25,990 total hip replacements (THRs) in 10,243 (46.6%) men and 11,754 (53.4%) women with a median age of 66 years (range, 20-96 years) at the time of arthroplasty. Our study confirmed that THA has an impressive efficiency and reliability in alleviating pain and improving function for almost all of the patients. Furthermore, the results are enduring with more than 90% of patients being satisfied with the outcome at 15 years. Clinical outcome measures reach their maximum at 2 to 5 years after arthroplasty and thereafter they decline gradually. Furthermore, patient age, gender, body mass index, and main diagnosis all have an influence on specific functional parameters. The Charnley classification has the most profound effect on the overall functional status of patients.