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Total hip arthroplasty after failed treatment of proximal femur fracture

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures.

Materials and methods

We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment.

Results

Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p < 0.0001). Postoperative complications in the trochanteric fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p < 0.0001 for both).

Conclusions

Performing THA after failed treatment of trochanteric fractures requires consideration of complication risk and incorrect femoral neck anteversion.

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References

  1. Orimo H, Yaegashi Y, Onoda T, Fukushima Y, Hosoi T, Sakata K (2009) Hip fracture incidence in Japan: estimates of new patients in 2007 and 20-year trends. Arch Osteoporos 4(1–2):71–77. doi:10.1007/s11657-009-0031-y

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256. doi:10.1007/s00198-012-1964-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105. doi:10.1038/nrrheum.2009.260

    Article  PubMed  Google Scholar 

  4. Hagino H, Nakamura T, Sakamoto K, Yamamoto K, Endo N, Mori S, Mutoh Y, Yamamoto S, Harada A, Kushida K, Tanizawa T, Hotokebuchi T, Takaoka K, Tomita K, Kawai S, Takahashi H, Inoue T, Kurokawa T, Yamamoto H (2004) Nationwide survey of hip fractures in Japan. J Orthop Sci 9(1):1–5. doi:10.1007/s00776-003-0741-8

  5. Jones HW, Johnston P, Parker M (2006) Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop 30(2):69–78. doi:10.1007/s00264-005-0028-0

    Article  PubMed  PubMed Central  Google Scholar 

  6. Varghese VD, Boopalan PR, Titus VT, Oommen AT, Jepegnanam TS (2014) Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy. J Orthop Trauma 28(7):410–416. doi:10.1097/bot.0000000000000030

    Article  PubMed  Google Scholar 

  7. Sen RK, Tripathy SK, Goyal T, Aggarwal S, Tahasildar N, Singh D, Singh AK (2012) Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft. Int Orthop 36(4):827–832. doi:10.1007/s00264-011-1344-1

    Article  PubMed  Google Scholar 

  8. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Tornkvist H, Ponzer S, Tidermark J (2011) Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Jt Surg Am 93(5):445–450. doi:10.2106/jbjs.j.00474

    Article  Google Scholar 

  9. Pachore JA, Shah VI, Sheth AN, Shah KP, Marothi DP, Puri R (2013) Hip arthroplasty in failed intertrochanteric fractures in elderly. Indian J Orthop 47(6):572–577. doi:10.4103/0019-5413.121581

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mahmoud SS, Pearse EO, Smith TO, Hing CB (2016) Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis. Bone Jt J 98-b(4):452–460. doi:10.1302/0301-620x.98b4.36922

    Article  CAS  Google Scholar 

  11. Khanuja HS, Vakil JJ, Goddard MS, Mont MA (2011) Cementless femoral fixation in total hip arthroplasty. J Bone Jt Surg Am 93(5):500–509. doi:10.2106/jbjs.j.00774

    Article  Google Scholar 

  12. Mulliken BD, Bourne RB, Rorabeck CH, Nayak N (1996) A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Jt Surg Am 78(8):1214–1225

    Article  CAS  Google Scholar 

  13. Engh CA, Glassman AH, Suthers KE (1990) The case for porous-coated hip implants. The femoral side. Clin Orthop Relat Res 261:63–81

    Google Scholar 

  14. Mulroy WF, Estok DM, Harris WH (1995) Total hip arthroplasty with use of so-called second-generation cementing techniques. A fifteen-year-average follow-up study. J Bone Jt Surg Am 77(12):1845–1852

    Article  CAS  Google Scholar 

  15. Harris WH, McCarthy JC Jr, O’Neill DA (1982) Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Jt Surg Am 64(7):1063–1067

    Article  CAS  Google Scholar 

  16. Sugano N, Noble PC, Kamaric E (1998) A comparison of alternative methods of measuring femoral anteversion. J Comput Assist Tomogr 22(4):610–614

    Article  CAS  PubMed  Google Scholar 

  17. Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, Altman R, Brandt K, Dougados M, Lequesne M (1997) Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol 24(4):799–802

    CAS  PubMed  Google Scholar 

  18. Mabry TM, Prpa B, Haidukewych GJ, Harmsen WS, Berry DJ (2004) Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Jt Surg Am 86-a(10):2263–2267

    Article  Google Scholar 

  19. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr (2013) Total hip arthroplasty after failed internal fixation of proximal femoral fractures. J Arthroplasty 28(1):168–171. doi:10.1016/j.arth.2012.04.003

    Article  PubMed  Google Scholar 

  20. Srivastav S, Mittal V, Agarwal S (2008) Total hip arthroplasty following failed fixation of proximal hip fractures. Indian J Orthop 42(3):279–286. doi:10.4103/0019-5413.41851

    Article  PubMed  PubMed Central  Google Scholar 

  21. Casper DS, Kim GK, Parvizi J, Freeman TA (2012) Morphology of the proximal femur differs widely with age and sex: relevance to design and selection of femoral prostheses. J Orthop Res 30(7):1162–1166. doi:10.1002/jor.22052

    Article  PubMed  Google Scholar 

  22. Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS (1988) The anatomic basis of femoral component design. Clin Orthop Relat Res 235:148–165

    Google Scholar 

  23. Zhang B, Chiu KY, Wang M (2004) Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplasty 19(3):329–333

    Article  PubMed  Google Scholar 

  24. Weiss RJ, Karrholm J, Hailer NP, Beckman MO, Stark A (2012) Salvage of failed trochanteric and subtrochanteric fractures using a distally fixed, modular, uncemented hip revision stem. Acta Orthop 83(5):488–492. doi:10.3109/17453674.2012.733917

    Article  PubMed  PubMed Central  Google Scholar 

  25. Abouelela AA (2012) Salvage of failed trochanteric fracture fixation using the Revitan curved cementless modular hip arthroplasty. J Arthroplasty 27(7):1382–1388. doi:10.1016/j.arth.2011.10.021

    Article  PubMed  Google Scholar 

  26. Exaltacion JJ, Incavo SJ, Mathews V, Parsley B, Noble P (2012) Hip arthroplasty after intramedullary hip screw fixation: a perioperative evaluation. J Orthop Trauma 26(3):141–147. doi:10.1097/BOT.0b013e318221ea6b

    Article  PubMed  Google Scholar 

  27. Enocson A, Hedbeck CJ, Tornkvist H, Tidermark J, Lapidus LJ (2012) Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop 36(4):711–717. doi:10.1007/s00264-011-1326-3

    Article  PubMed  Google Scholar 

  28. Enocson A, Mattisson L, Ottosson C, Lapidus LJ (2012) Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop 83(5):493–498. doi:10.3109/17453674.2012.688724

    Article  PubMed  PubMed Central  Google Scholar 

  29. Haidukewych GJ (2009) Salvage of failed treatment of femoral neck fractures. Instr Course Lect 58:83–90

    PubMed  Google Scholar 

  30. Fukui N, Watanabe Y, Nakano T, Sawaguchi T, Matsushita T (2012) Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: a 1-year prospective cohort study. J Orthop Trauma 26(3):163–171. doi:10.1097/BOT.0b013e31821e1261

    Article  PubMed  Google Scholar 

  31. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD (1997) Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 11(3):162–165

    Article  CAS  PubMed  Google Scholar 

  32. Willis-Owen CA, Konyves A, Martin DK (2010) Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Jt Surg Br 92(8):1128–1133. doi:10.1302/0301-620x.92b8.24333

    Article  Google Scholar 

  33. Krause PC, Braud JL, Whatley JM (2015) Total hip arthroplasty after previous fracture surgery. Orthop Clin North Am 46(2):193–213. doi:10.1016/j.ocl.2014.11.006

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan

    Tomonori Tetsunaga, Hirosuke Endo, Tomoyuki Noda, Tomoko Tetsunaga & Toshifumi Ozaki

  2. Department of Orthopaedic Surgery, Okayama Medical Center, 1711-1 Tamasu, Kitaku, Okayama, 701-1192, Japan

    Tomonori Tetsunaga, Toru Sato & Naofumi Shiota

  3. Department of Intelligent Orthopaedic Systems, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan

    Kazuo Fujiwara

Authors
  1. Tomonori Tetsunaga
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  2. Kazuo Fujiwara
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  3. Hirosuke Endo
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  4. Tomoyuki Noda
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  5. Tomoko Tetsunaga
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Correspondence to Tomonori Tetsunaga.

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Tetsunaga, T., Fujiwara, K., Endo, H. et al. Total hip arthroplasty after failed treatment of proximal femur fracture. Arch Orthop Trauma Surg 137, 417–424 (2017). https://doi.org/10.1007/s00402-017-2631-0

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