Advertisement

International Orthopaedics

, Volume 36, Issue 4, pp 731–734 | Cite as

Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

  • Benjamin John Floyd DeanEmail author
  • Jon J. Matthews
  • Andrew Price
  • David Stubbs
  • Duncan Whitwell
  • Christopher M. L. H. Gibbons
Original Paper

Abstract

Purpose

Although originally designed for reconstruction after primary malignant bone tumour resection, modular endoprosthetic replacement (EPR) can be used in salvage surgery for complex periprosthetic fracture and failed internal fixation. The purpose of this study was to assess the functional outcome following EPR for failed internal fixation of the proximal femur.

Methods

We assessed clinical and functional outcomes of using a modular tumour endoprosthesis to reconstruct the proximal femur following failed internal fixation in eight consecutive patients between 2001 and 2008.

Results

There were four men and four women, with a mean age of 67.5 (range 50–79) years and a mean follow-up of 16.5 (6–36) months. All patients had failed internal fixation for traumatic proximal femoral fractures—four 31.A2.3, two 31.A3.1, two 31.A3.3 using the Arbeitsgemeinshaft für Osteosynthesefragen (AO) fracture classification. Mean time from the first attempted internal fixation to definitive EPR was 34 (6–102) months, and the median number of previous surgical procedures was two (1–11). Histology revealed infection (two cases), uninfected nonunion (five cases) and plasmocytoma (one case). The EPR was carried out as a one-stage procedure in six cases and a two-stage procedure in two cases. Mean postoperative Harris Hip Score was 71.4 (range 64–85). There were no surgical complications. One patient died as a result of systemic complications of myeloma several years following EPR.

Conclusions

EPR is an effective salvage procedure for failed fixation of traumatic proximal femoral fractures. Immediate weightbearing and a good functional outcome can be expected in this difficult group of patients.

Keywords

Internal Fixation Proximal Femur Proximal Femoral Fracture Dynamic Condylar Screw Bone Tumour Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Chandrasekar CR, Grimer RJ et al (2009) Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br 91-B:108–112CrossRefGoogle Scholar
  2. 2.
    Freedman EL, Eckardt JJ (1997) A modular endoprosthetic system for tumor and non-tumor reconstruction: preliminary experience. Orthopedics 20(1):27–36PubMedGoogle Scholar
  3. 3.
    Anderson GH, Raymakers R, Gregg PJ (1993) The incidence of proximal femoral fractures in an English county. J Bone Joint Surg Br 75-B(3):441Google Scholar
  4. 4.
    Sharma H, De Leeuw J, Rowley DI (2005) Girdlestone resection arthroplasty following failed surgical procedures. Int Orthop 29(2):92–95PubMedCrossRefGoogle Scholar
  5. 5.
    Bourne RB, Hunter GA, Rorabeck CH, Macnab JJ (1984) A six-year follow-up of infected total hip replacements managed by Girdlestone's arthroplasty. J Bone Joint Surg Br 66-B(3):340–343Google Scholar
  6. 6.
    Haddad FS, Muirhead-Allwood SK, Manktelow ARJ, Bacarese-Hamilton I (2000) Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 82-B:689–694CrossRefGoogle Scholar
  7. 7.
    Zhang B, Chiu K, Wang M (2004) Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplast 19(3):329–333CrossRefGoogle Scholar
  8. 8.
    Schröder J, Saris D, Besselaar PP, Marti RK (1998) Comparison of the results of the Girdlestone pseudarthrosis with reimplantation of a total hip replacement. Int Orthop 22(4):215–218PubMedCrossRefGoogle Scholar
  9. 9.
    Jaiswal PK, Jagiello J, David LA, Blunn G, Carrington RW, Skinner JA, Cannon SR, Briggs TW (2008) Use of an 'internal proximal femoral replacement' with distal fixation in revision arthroplasty of the hip. J Bone Joint Surg Br 90(1):11–15PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Benjamin John Floyd Dean
    • 1
    Email author
  • Jon J. Matthews
    • 1
  • Andrew Price
    • 1
  • David Stubbs
    • 1
  • Duncan Whitwell
    • 1
  • Christopher M. L. H. Gibbons
    • 1
  1. 1.Nuffield Orthopaedic CentreOxfordUK

Personalised recommendations