Total hip arthroplasty for intertrochanteric fracture fixation failure

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Abstract

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.

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Most cited references 23

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Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database.

, John N Weinstein, J Anglen (2008)

A new method of fixation for intertrochanteric hip fractures that involves the use of an intramedullary nail that interlocks proximally into the femoral head was introduced in the early 1990s. Anecdotal observation of practice patterns during the Part II (oral) American Board of Orthopaedic Surgery examination suggested that the use of this method had increased substantially in recent years in comparison with the more traditional sliding compression screw technique. A study of the Part II database was undertaken to detect changing patterns of care for intertrochanteric fractures. During the process of Board certification, candidates for the Part II (oral) examination submit a six-month surgical case list and patient data into a secure database. The database was searched for all intertrochanteric fractures (International Classification of Diseases, Ninth Revision, code 820.20 or 820.21) over a seven-year period (1999 through 2006). The cases were categorized by intramedullary nail or plate fixation on the basis of surgeon-reported Current Procedural Terminology codes. Relative utilization of the two devices was analyzed according to year and region, and the devices were compared in terms of complications and outcomes. A dramatic change in practice was demonstrated, with the intramedullary nail fixation rate increasing from 3% in 1999 to 67% in 2006. Regional variation was substantial. The highest rate of utilization of intramedullary nail fixation was recorded by candidates from the South, Southeast, and Southwest, who converted to the new technology faster than those in the Northeast, Northwest, and Midwest. Overall, patients managed with plate fixation had slightly less pain and deformity in comparison with those managed with intramedullary nailing, with no significant differences being identified in terms of function or satisfaction. Patients managed with intramedullary nailing had more procedure-related complications, particularly bone fracture. From 1999 to 2006, a dramatic change in surgeon preference for the fixation device used for the treatment of intertrochanteric fractures has occurred among young orthopaedic surgeons. This change has occurred despite a lack of evidence in the literature supporting the change and in the face of the potential for more complications.

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Prevalence of osteonecrosis of the femoral head: a nationwide epidemiologic analysis in Korea.

Joon Soon Kang, Sohee Park, Joo Hyoun Song … (2009)

This study was performed to estimate the prevalence of osteonecrosis of the femoral head in Korea. Using medical claims data from the Korean National Health Insurance Corporation, all individuals treated under a diagnosis of osteonecrosis of the femoral head were identified for each year from 2002 to 2006. Among them, the number of true cases was estimated using a randomly collected validation sample of 382 patients for which the actual diagnosis was investigated by authors. The estimated yearly prevalence per 100 000 population ranged from 20.53 (20.13

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Fulfillment of patients' expectations for total hip arthroplasty.

Thomas Sculco, Eduardo A. Salvati, Carol Mancuso … (2009)

Fulfillment of patient expectations is an important outcome of total hip arthroplasty. The objective of the present study was to determine the proportion of expectations that were fulfilled following total hip arthroplasty as well as how the fulfillment of expectations relates to patient and clinical characteristics. Preoperatively, patients completed the Hospital for Special Surgery Hip Replacement Expectations Survey, measuring physical and psychological expectations, and the American Academy of Orthopaedic Surgeons Lower Limb Core Scale, measuring symptoms and function. Approximately four years after surgery, patients were interviewed by telephone and were asked whether each expectation that they had cited preoperatively had been fulfilled. Four hundred and five patients were interviewed. The mean age of the patients was sixty-six years, and 58% of the patients were women. Forty-three percent of the patients reported that all of their expectations had been fulfilled completely. For the entire sample, the mean proportion of expectations that had been fulfilled completely was 87%. Patients who were younger, who were employed, who had a body mass index of <35 kg/m(2), who did not have complications, who did not have a postoperative limp, and who had better preoperative and postoperative Lower Limb Core scores had a greater proportion of expectations fulfilled (p

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Author and article information

Contributors

Yanzheng Gao: gyz9998@yeah.net

Journal

Journal ID (nlm-ta): Eur J Med Res

Journal ID (iso-abbrev): Eur. J. Med. Res

Title: European Journal of Medical Research

Publisher: BioMed Central (London )

ISSN (Print): 0949-2321

ISSN (Electronic): 2047-783X

Publication date (Electronic): 27 December 2019

Publication date PMC-release: 27 December 2019

Publication date Collection: 2019

Volume: 24

Electronic Location Identifier: 39

Affiliations

[1 ]ISNI 0000 0000 9139 560X, GRID grid.256922.8, School of Medicine, , Henan University, ; Kaifeng, 475004 Henan People’s Republic of China

[2 ]Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 45000 Henan People’s Republic of China

[3 ]ISNI 0000 0001 2189 3846, GRID grid.207374.5, Henan Provincial People’s Hospital, , Zhengzhou University People’s Hospital, ; 7 Weiwu Road, Zhengzhou, 450003 Henan People’s Republic of China

Article

Publisher ID: 398

DOI: 10.1186/s40001-019-0398-1

PMC ID: 6935170

PubMed ID: 31882018

SO-VID: 42438525-cfab-4413-904e-54bd46ff2cbe

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 5 August 2019

Date accepted : 2 December 2019

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: elderly patient,intertrochanteric fracture,fixation failure,hip,arthroplasty

Data availability:

ScienceOpen disciplines: Medicine

Keywords: elderly patient, intertrochanteric fracture, fixation failure, hip, arthroplasty

Total hip arthroplasty for intertrochanteric fracture fixation failure

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Abstract

Background

Methods

Results

Conclusion

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 23

Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database.

Prevalence of osteonecrosis of the femoral head: a nationwide epidemiologic analysis in Korea.

Fulfillment of patients' expectations for total hip arthroplasty.

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