Abstract
Introduction
The risk of hip dislocation after revision total hip arthroplasty is up to 20% following surgery for periprosthetic fractures. A technique was developed by the senior authors, involving a transtrochanteric osteotomy and superior capsulotomy to attempt to minimise this risk(1).
Methods
This prospective study examines a cohort of 40 patients undergoing this novel technique, which involves extending the fracture proximally to the tip of the greater trochanter. This is then extended into the soft tissues in the mid lateral plane as a split of the glutei and a minimally superior capsulotomy (preserving the anterior and posterior capsule). This allows for revision of the femoral component, and retention of the socket and liner. The outcomes of interest to the authors were dislocation rates, clinical outcome measured using the Oxford hip score. These were assessed along with X-ray imaging at 1, 2 and 5-year intervals to confirm fracture union and measure stem subsidence.
Results
Patients averaged 80 years of age, with a higher ratio of females (3:2). There were no cases of hip joint dislocations. Two patients (5%) underwent subsequent revision hip arthroplasty within the first 12 months of initial revision.
Femoral stem subsidence at 1 year averaged 5.9 mm. All fractures showed radiological evidence of union. The Oxford hip score was fair, averaging 31/48 by 1 year post-op, and then plateaued at 32.8/48 at 2 years post-op.
Conclusion
5 year follow-up of this novel operative technique in revision arthroplasty of Vancouver B periprosthetic hip fractures has confirmed the benefits, with no cases of hip dislocation, along with overall satisfactory patient clinical outcomes.
