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Published on: June 6, 2025
Hip arthroplasty for failed internal fixation of intertrochanteric fractures
Bosong Zhang1, Kwong-Yuen Chiu, Manyi Wang
1Department of Orthopaedic Trauma, Jishuitan Hospital, Beijing, People's Republic of China.
Insights
Hip arthroplasty effectively treats complications from intertrochanteric fracture fixation, significantly improving patient function. This study shows good outcomes with no mechanical failures, despite common surgical complications.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Arthroplasty
Background:
- Internal fixation of intertrochanteric fractures can lead to complications requiring further surgical intervention.
- Hip arthroplasty is a potential salvage procedure for managing these complex cases.
Purpose of the Study:
- To evaluate the outcomes of hip arthroplasty in patients with complications following internal fixation of intertrochanteric fractures.
- To assess functional improvement and complications associated with this conversion procedure.
Main Methods:
- Retrospective review of 19 patients who underwent hip arthroplasty (16 total hip arthroplasty, 3 bipolar hip arthroplasty) for post-fixation complications.
- Analysis of patient demographics, interval from fracture to arthroplasty, prosthesis type, and surgical complications.
- Functional outcome assessment using the Harris Hip Score pre- and post-operatively.
Main Results:
- The mean age at fracture was 64.1 years, with an average follow-up of 7.4 years post-arthroplasty.
- Significant improvement in Harris Hip Score from 38.4 pre-operatively to 79.8 post-operatively.
- Common complications included intraoperative greater trochanter fracture and postoperative dislocation; however, no revisions for mechanical failure were reported.
Conclusions:
- Hip arthroplasty is a viable option for managing complications of intertrochanteric fracture fixation, leading to substantial functional recovery.
- While surgical complications can occur, the long-term mechanical integrity of the prosthesis appears reliable in this patient cohort.
Abstract:
Nineteen patients who had hip arthroplasties for complications of internal fixation of intertrochanteric fractures were reviewed. There were 6 males and 13 females. The mean age was 64.1 years (range, 21-87 years) at the time of the fracture. The average interval from fracture to arthroplasty was 40.3 months (range, 2-288 months). The prosthesis types included 16 total hip arthroplasties and 3 bipolar hip arthroplasties. A standard femoral stem was used in every patient, and although the stem length did not extend well beyond the most distal screw holes, there was no stress fracture. Complications such as intraoperative fracture of the greater trochanter and postoperative dislocation were common. The Harris Hip Score significantly improved from 38.4 points before the conversion to 79.8 points after an average follow-up of 7.4 years (range, 2-18 years). There was no revision for mechanical failure.
