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Outcomes of Total Hip Replacement for Failed Hemiarthroplasty
Natesan Rajkumar1, Dhanasekaran Soundarrajan1, Gowtham Ram1
1Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043 India.
Insights
Conversion total hip replacement (THR) after hemiarthroplasty failure offers good functional outcomes and pain relief. This challenging procedure shows reliable results, though caution is advised due to potential fractures.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
- Biomedical Engineering
Background:
- Hemiarthroplasty is a common procedure for hip fractures.
- Failure of hemiarthroplasty necessitates revision surgery, often conversion total hip replacement (THR).
- Conversion THR presents unique surgical challenges compared to primary THR.
Purpose of the Study:
- To analyze the outcomes of conversion total hip replacement (THR) following failed hemiarthroplasty.
- To evaluate functional improvement and complications associated with this revision procedure.
Main Methods:
- Retrospective analysis of 104 patients undergoing conversion THR for failed hemiarthroplasty (2012-2018).
- Assessment of demographic data, surgical details, functional status (modified Harris Hip Score - HHS), and complications.
- Radiographic analysis for osteolysis, migration, and subsidence.
Main Results:
- 73 patients included in final analysis with an average follow-up of 48.2 months.
- Significant improvement in mean HHS from 38.5 preoperatively to 80.9 postoperatively (p < 0.05).
- Low rates of complications including deep infection (1), heterotopic ossification (1), intraoperative calcar fracture (11), and postoperative periprosthetic fracture (2). No dislocations or neurovascular complications.
Conclusions:
- Conversion THR for failed hemiarthroplasty is a viable option yielding good functional outcomes and pain relief.
- The procedure is associated with a notable incidence of peri-prosthetic fractures, requiring careful surgical technique.
- Reliable outcomes can be achieved with proper prosthesis orientation and soft tissue balancing, even in complex cases.
Aim:
Our study aims to analyze the outcomes of conversion total hip replacement (THR) done for failed hemiarthroplasty.
Patients And Methods:
We retrospectively analyzed 104 consecutive patients who underwent conversion THR for failed hemiarthroplasty between January 2012 and December 2018. The patient's records were analyzed for demographic information, index surgery details, preoperative functional status, and perioperative complications. Patients were analyzed according to the various modes of failure of hemiarthroplasty. The radiographs were analyzed for any progressive osteolysis, cup migration and stem subsidence. All the patients were evaluated using the modified Harris hip score (HHS) for clinical outcome. Complications, revision or reoperation in the follow-up period was recorded.
Results:
A total of 73 patients were included in the study for final analysis after exclusion criteria. The average follow-up was 48.2 ± 29.6 months. There was a significant improvement in mean HHS from 38.5 ± 9.1 preoperatively to 80.9 ± 4.3 at the last follow-up (p < 0.05). The different modes of failure had no statistically significant difference in the postoperative Harris hip score (p = 0.393). None of the patients had progressive radiolucent lines more than 2 mm or significant subsidence in the final follow-up compared to the initial postoperative radiograph. There was one deep infection, one patient had grade 2 heterotopic ossification, intraoperative calcar fracture was fixed with cerclage wiring in 11 patients, and postoperative periprosthetic fracture in two patients was treated with plate osteosynthesis. There were no neurovascular complications or dislocation during the follow-up.
Conclusion:
Conversion THR for failed hemiarthroplasty is a challenging procedure and results in good functional outcome and provides reliable pain relief. Conversion THA for septic loosening by two stage revision have comparable postoperative outcomes like THA for aseptic loosening. Caution is required owing to high incidence of peri-prosthetic fracture during conversion THA. Dislocation rate is negligible even with smaller head provided the prosthesis is implanted in the proper orientation and adequate soft tissue balancing is achieved.
