Salvage of failed dynamic hip screw fixation of intertrochanteric fractures

Failure of intertrochanteric fracture fixation can occur in patients with poor bone quality, extreme osteoporosis, or unstable fracture arrangement. Although hip replacement is a commonly successful process, it includes technical problems, such as implant removal, bone loss, low bone quality, nonunion of trochanter, and difficult surgical exposure. The goal of this study was to restore total hip replacement for failed intertrochanteric fractures to assess the outcomes.

During April 2009 to October 2015, 203 patients (203 hips) underwent total hip arthroplasty through the direct lateral approach, as salvage of failed intertrochanteric fracture management by dynamic hip screw (DHS). The restoration process was done by a direct lateral approach (Hardinge) in all hips. The operation details, such as duration, blood transfusion volume, blood loss, and duration of hospital stay, were recorded. Modified Harris hip score (MHHS) was applied for assessment of clinical outcome before and after the operation, and during the follow-up.

Overall, 112 patients were male (55.17%) and 91 patients (44.8%) were female and the mean of age was 72.58±10.60 years old. Average operation time was 93.96±10.72 minutes. The mean blood loss volume during the operation was 355.86±84.11 mL. The mean preoperative MHHS score was 39.55±6.74 (range: 30-50). The MHHS score improved to 90.55±2.24, 92.34±1.26, and 94.34±1.85 during the first, second, and final follow-up, respectively (P<0.0001). Infection was found in only two patients, who had undergone one stage revision and linear of the cup was exchanged. Total rate of complications during the follow-up was 4.92%.

The current research was a large population study and indicated that sufficient functional outcome could be obtained by total hip replacement in geriatrics with failed intertrochanteric fractures. Therefore, well-performed hip replacement could be a suitable choice for restoring failed DHS in unsuccessfully managed intertrochanteric fractures in the elderly.