Safety and efficacy of total hip arthroplasty following failed internal fixation of intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Yongzhi ^1,2 , ZHOU Kai ¹ , WANG Duan ¹ ,  ZHOU Zongke ¹ , YANG Jing ¹ , KANG Pengde ¹ , PEI Fuxing ¹ , SHEN Bin ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopedics, the People，s Hospital of Guang’an, Guang’an Sichuan, 638000, P.R.China;

Corresponding author：

ZHOU Zongke, Email: zongke@126.com

Keywords：

Intertrochanteric fracture; total hip arthroplasty; internal fixation; safety; efficacy

DOI：

10.7507/1002-1892.201807089

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Objective To evaluate the safety and efficacy of total hip arthroplasty (THA) following failed internal fixation of intertrochanteric fractures. Methods Between January 2007 and January 2016, THAs were performed in 32 patients (33 hips) for failed internal fixation of intertrochanteric fractures. There were 15 males and 17 females, with mean age of 74.0 years old (range, 65-87 years). There were 3 hips of Evans-Jensen type Ⅱ, 10 hips of type Ⅲ, 8 hips of type Ⅳ, and 12 hips of type Ⅴ. The fractures were fixed with dynamic hip screw in 18 hips, proximal femoral nail antirotation in 9 hips, locking plate in 5 hips, and hollow screw in 1 hip. The internal fixation failure caused by fracture displacement and nonunion in 22 patients, traumatic arthritis in 6 patients, fracture nonunion and infection in 3 patients, and avascular necrosis of the femoral head in 2 patients. The mean interval from initial fracture fixation to THA was 20 months (range, 2-48 months). The safety evaluation indicators included operation time, amount of operative bleeding and postoperative drainage, blood transfusion, and perioperative complications. The efficacy indexes included the hip Harris score, the range of motion (ROM), visual analogue scale (VAS) score, and the length difference between both legs; the X- ray films were taken to assess the prosthesis survival condition. Results The average operation time was 92 minutes (range, 55–135 minutes). The average amount of operative bleeding and postoperative drainage were 480 mL (range, 360-620 mL) and 350 mL (range, 220-520 mL), respectively. Intraoperative proximal femur fissure fracture occurred in 2 hips. After operation, 10 cases received allogeneic blood transfusion, 1 case occurred cerebral infarction, 2 hips experienced dislocation, 1 hip occurred greater trochanter re-fracture and dislocation because of spraining, and 1 case died of myocardial infarction. Twenty-nine patients (30 hips) were followed up 2-10 years (mean, 4.9 years). At last follow-up, there was no infection recurrence in 3 infected hips, and there was no prosthesis loosening, subsidence, or rupture in all cases. The Harris score, ROM, VAS score, and the length difference between both legs were significantly superior to preoperative ones (P<0.05). Conclusion THA is an effective salvage procedure after failed internal fixation of intertrochanteric fracture. But its perioperative risks and complications are pretty high. Adequate preoperative evaluation, elaborate and individualized perioperative management are keys to make sure the patient can safely survive the perioperative period.

Citation： QIN Yongzhi, ZHOU Kai, WANG Duan, ZHOU Zongke, YANG Jing, KANG Pengde, PEI Fuxing, SHEN Bin. Safety and efficacy of total hip arthroplasty following failed internal fixation of intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 160-165. doi: 10.7507/1002-1892.201807089 Copy

1.	Socci AR, Casemyr NE, Leslie MP, et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J, 2017, 99-B(1): 128-133.
2.	Lee SH, Chen IJ, Li YH, et al. Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006-2010. Acta Orthop Traumatol Turc, 2016, 50(4): 437-442.
3.	Desteli E, Imren Y, Erdoğan M, et al. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med, 2015, 38(2): E63-E72.
4.	Arslan A, Utkan A, Koca TT. Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures. Indian J Orthop, 2016, 50(6): 636-640.
5.	Teague DC, Ertl WJ, Hickerson L, et al. What is new in orthopaedic trauma. J Bone Joint Surg (Am), 2016, 98(13): 1142-1149.
6.	Matre K, Havelin LI, Gjertsen JE, et al. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in Norwegian Hip Fracture Register. Injury, 2013, 44(6): 735-742.
7.	Ovesen O, Andersen M, Poulsen T, et al. The trochanteric gamma nail versus the dynamic hip screw: a prospective randomized study. One-year follow-up of 146 intertrochanteric fractures. Hip Int, 2006, 16(4): 293-298.
8.	Yuan BJ, Abdel MP, Cross WW, et al. Hip arthroplasty after surgical treatment of intertrochanteric hip fractures. J Arthroplasty, 2017, 32(11): 3438-3444.
9.	Winemaker M, Gamble P, Petruccelli D, et al. Short-term outcomes of total hip arthroplasty after complications of open reduction internal fixation for hip fracture. J Arthroplasty, 2006, 21(5): 682-688.
10.	Srivastav S, Mittal V, Agarwal S. Total hip arthroplasty following failed fixation of proximal hip fractures. Indian J Orthop, 2008, 42(3): 279-286.
11.	Tsai SW, Chen CF, Wu PK, et al. Does implant selection impact postoperative complications following hip arthroplasty for failed intertrochanteric fractures? A retrospective comparative study Artif Organs, 2016, 40(8): 798-804.
12.	Lee YK, Kim JT, Alkitaini AA, et al. Conversion hip arthroplasty in failed fixation of intertrochanteric fracture: A propensity score matching study. J Arthroplasty, 2017, 32(5): 1593-1598.
13.	周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复-围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
14.	Flören M, Lester DK. Durability of implant fixation after less-invasive total hip arthroplasty. J Arthroplasty, 2006, 21(6): 783-790.
15.	Cho CH, Yoon SH, Kim SY. Better functional outcome of salvage THA than bipolar hemiarthroplasty for failed intertrochanteric femur fracture fixation. Orthopedics, 2010, 33(10): 721-726.
16.	Chen DW, Lin CL, Hu CC, et al. Biomechanical consideration of total hip arthroplasty following failed fixation of femoral intertrochanteric fractures-a finite element analysis. Med Eng Phys, 2013, 35(5): 569-575.
17.	Greidanus NV, Masri BA, Garbuz DS, et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. J Bone Joint Surg (Am), 2007, 89(7): 1409-1416.
18.	Mabry TM, Prpa B, Haidukewych GJ, et al. Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg (Am), 2004, 86-A(10): 2263-2267.
19.	Chen YT, Chen WM, Lee KS, et al. Diaphyseal locking hip arthroplasty for treatment of failed fixation of intertrochanteric hip fractures. J Arthroplasty, 2008, 23(2): 241-246.
20.	Pui CM, Bostrom MP, Westrich GH, et al. Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures: a multi-center study. J Arthroplasty, 2013, 28(8 Suppl): 45-47.
21.	Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type IV developmental dysplasia. J Arthroplasty, 2016, 32(4): 1211-1219.
22.	White TO, Dougall TW. Arthroplasty of the hip. Leg length is not important. J Bone Joint Surg (Br), 2002, 84(3): 335-338.
23.	孙菁阳, 周勇刚, 高志森, 等. 人工全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良术中应用粗隆下截骨的相关研究. 中国修复重建外科杂志, 2018, 32(2): 152-156.
24.	朱建辛, 王跃, 庞健, 等. 人工全髋关节置换术治疗重度成人髋关节发育不良疗效分析. 中国修复重建外科杂志, 2014, 28(3): 335-338.

1. Socci AR, Casemyr NE, Leslie MP, et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J, 2017, 99-B(1): 128-133.
2. Lee SH, Chen IJ, Li YH, et al. Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006-2010. Acta Orthop Traumatol Turc, 2016, 50(4): 437-442.
3. Desteli E, Imren Y, Erdoğan M, et al. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med, 2015, 38(2): E63-E72.
4. Arslan A, Utkan A, Koca TT. Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures. Indian J Orthop, 2016, 50(6): 636-640.
5. Teague DC, Ertl WJ, Hickerson L, et al. What is new in orthopaedic trauma. J Bone Joint Surg (Am), 2016, 98(13): 1142-1149.
6. Matre K, Havelin LI, Gjertsen JE, et al. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in Norwegian Hip Fracture Register. Injury, 2013, 44(6): 735-742.
7. Ovesen O, Andersen M, Poulsen T, et al. The trochanteric gamma nail versus the dynamic hip screw: a prospective randomized study. One-year follow-up of 146 intertrochanteric fractures. Hip Int, 2006, 16(4): 293-298.
8. Yuan BJ, Abdel MP, Cross WW, et al. Hip arthroplasty after surgical treatment of intertrochanteric hip fractures. J Arthroplasty, 2017, 32(11): 3438-3444.
9. Winemaker M, Gamble P, Petruccelli D, et al. Short-term outcomes of total hip arthroplasty after complications of open reduction internal fixation for hip fracture. J Arthroplasty, 2006, 21(5): 682-688.
10. Srivastav S, Mittal V, Agarwal S. Total hip arthroplasty following failed fixation of proximal hip fractures. Indian J Orthop, 2008, 42(3): 279-286.
11. Tsai SW, Chen CF, Wu PK, et al. Does implant selection impact postoperative complications following hip arthroplasty for failed intertrochanteric fractures? A retrospective comparative study Artif Organs, 2016, 40(8): 798-804.
12. Lee YK, Kim JT, Alkitaini AA, et al. Conversion hip arthroplasty in failed fixation of intertrochanteric fracture: A propensity score matching study. J Arthroplasty, 2017, 32(5): 1593-1598.
13. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复-围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
14. Flören M, Lester DK. Durability of implant fixation after less-invasive total hip arthroplasty. J Arthroplasty, 2006, 21(6): 783-790.
15. Cho CH, Yoon SH, Kim SY. Better functional outcome of salvage THA than bipolar hemiarthroplasty for failed intertrochanteric femur fracture fixation. Orthopedics, 2010, 33(10): 721-726.
16. Chen DW, Lin CL, Hu CC, et al. Biomechanical consideration of total hip arthroplasty following failed fixation of femoral intertrochanteric fractures-a finite element analysis. Med Eng Phys, 2013, 35(5): 569-575.
17. Greidanus NV, Masri BA, Garbuz DS, et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. J Bone Joint Surg (Am), 2007, 89(7): 1409-1416.
18. Mabry TM, Prpa B, Haidukewych GJ, et al. Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg (Am), 2004, 86-A(10): 2263-2267.
19. Chen YT, Chen WM, Lee KS, et al. Diaphyseal locking hip arthroplasty for treatment of failed fixation of intertrochanteric hip fractures. J Arthroplasty, 2008, 23(2): 241-246.
20. Pui CM, Bostrom MP, Westrich GH, et al. Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures: a multi-center study. J Arthroplasty, 2013, 28(8 Suppl): 45-47.
21. Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type IV developmental dysplasia. J Arthroplasty, 2016, 32(4): 1211-1219.
22. White TO, Dougall TW. Arthroplasty of the hip. Leg length is not important. J Bone Joint Surg (Br), 2002, 84(3): 335-338.
23. 孙菁阳, 周勇刚, 高志森, 等. 人工全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良术中应用粗隆下截骨的相关研究. 中国修复重建外科杂志, 2018, 32(2): 152-156.
24. 朱建辛, 王跃, 庞健, 等. 人工全髋关节置换术治疗重度成人髋关节发育不良疗效分析. 中国修复重建外科杂志, 2014, 28(3): 335-338.

Chinese Journal of Reparative and Reconstructive Surgery

Safety and efficacy of total hip arthroplasty following failed internal fixation of intertrochanteric fractures

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