A clinical study on arthroplasty for failed internal fixation of hip fractures and review of literature

BACKGROUND & OBJECTIVE: Hip fracture is common osteoporotic fracture associated sometimes with failed internal fixation. Joint replacement is commonly used to salvage failed internal fixation of hip fractures (FIFHF). Our objective was to present the outcome of Arthroplasty after FIFHF in our patients. METHODS: A prospective analysis was made on consecutive patients who underwent prosthetic replacements for FIFHF in Orthopaedics Department of Xuanwu Hospital between June 2012 and January 2015. Fifty six patients were included. There were 32 cases of failed internal fixation of femoral neck fracture (FIFFNF) and 24 cases of failed internal fixation of intertrochanteric fracture (FIFIF). The reoperations included 36 cases of total hip replacements, and 20 cases of bipolar femoral head replacements. Cemented prostheses were used in 19 patients (long-stems in 7 patients), and uncemented prostheses in 37 patients (long-stems in 12 patients). The patients were followed up for a minimum of 12 months or until their death. RESULTS: Two patients died of pulmonary infection in the perioperative period, two died of myocardial infarction in two months after the operation, and the rest survived 12 month follow-up at the least. The mean Harris hip scores of the patients were 47 and 85 before and after the operation, respectively. The rate of Excellent and Good results is 82.7%. T tests showed that difference between pre and post-operation Harris hip scores is statistically significant (p <0.001). CONCLUSIONS: Arthroplasty may serve as a suitable salvage technique for FIFHF, and long-stem prosthesis replacement is proved to obtain reliable curative effect, especially in FIFIF.