Abstract
Objective
To evaluate the volume of cases, causes of failure, complications in patients with a failed Thompson hemiarthroplasty.
Methods
A retrospective review was undertaken between 2005–11, of all Thompson implant revised in the trust. Patients were identified by clinical coding. All case notes were reviewed.
Data collection included patients demographic, time to revision, reason for revision, type of revision implant, surgical time and technique, transfusion, complications, HDU stay, mobility pre and post revision,
Results
23 patients were identified, age 81 years (range 76–90). male to female ratio was 2:21, 11 right and 12 left hip. Mean time to failure was 50 months (1–104 m) range, mean follow up post revision surgery 26 months (3–77).
Reason for revision was dislocation in 3 patients (13%), femoral loosening 5 (21%), peri-prosthetic fracture 3 (13%), Infection 6 (26%) and acetabular erosion 6 (26%).
There were six infected cases in the study which was all aspirated preoperatively off which only 4 were positive. All infected cases grew an organism from intra-operative specimens. (80% cases) were coagulase negative Staphylococcus aureus. 35% only positive on enrichment cultures
4 infected Thompsons were revised successfully with 2 stage revisions. One patient died after 1st stage and another was able to mobilise after the first stage with a cement spacer and refused further surgery.
Mean surgical time was 3.5 hours (range 2.5–5.5)
HDU stay 1.3 days (range 0–6). 6 deaths in total, 3 unrelated, 3 post operative
Complications included 1 fracture requiring revision, 1 dislocation, 1 foot drop and 4 chest infection of which two patients died from this.
Conclusion
We identified a revision rate of 1.2%, complication occurred in 43% of cases with a one year mortality of 26%.
Failed Thompson revision surgery is rare, challenging and patient selection is important to reduce postoperative morbidity and mortality.
