Background: Intertrochanteric fracture is a common fracture suffered by elderly patients. Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fixation failure, which remains somewhat controversial due to some clinical potential issues.
Methods: 18 elderly patients (average age 70.3 years) each with intertrochanteric fracture fixation failure treated with THA between September 2013 and October 2016 were retrospectively analyzed. Internal fixation treatments involved 5 patients who had received proximal femoral nail anti-rotation, 7 who received locking proximal femur plates and 6 who received dynamic hip screws. All patients were treated with THA using biological acetabular prosthesis and hip arthroplasty (HA) coating skillet femoral prosthesis, with the greater trochanter fixed using wire or steel when necessary. Patients' Harris scores pre- and post-treatment, SF-36 Health Questionnaire score and digital radiology (DR) were used for joint prostheses initial stability and survival evaluation.
Results: 15 patients completed follow-up periods ranging between 19 and 54 months (mean 26.2 months; 1 patient died from a pulmonary embolism, 1 patient died from pulmonary heart disease 1 year after surgery and 1 patient withdrew for personal reasons). There were no joint infections, periprosthetic fractures or dislocations. The average Harris score increased significantly, from 32.68 ± 12.04 points before surgery to 91.08 ± 5.9 points at 24 months post-treatment. SF-36 scores were significantly increased.
Conclusion: THA as salvage treatment for failed internal fixation of intertrochanteric femoral fractures in elderly patients significantly reduced hip pain and restored joint function, and early clinical outcomes were satisfactory.
Keywords: Arthroplasty; Elderly patient; Fixation failure; Hip; Intertrochanteric fracture.