Failed internal fixation of hip fracture is a problem with varied aetiology. This becomes more complex when associated with infection. Total hip arthroplasty (THA) remains the only option to restore hip biomechanics when there is partial/complete head destruction associated with it. A retrospective review was performed for 22 consecutive patients of THA following failed infected internal fixation between Sept. 2001 and Nov. 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, six failed osteotomies following proximal femoral fractures and five failed screw fixations for transcervical fractures. The average age of the patients was 48.5 years and average follow up period was 3.5 years (16 months–7.5 years). All the patients have undergone two stage revision surgeries. The average Harris Hip Score improved from 35.5 to 82.8 at the latest follow up. None of the patients had recurrence of infection. One patient developed sciatic nerve palsy, recovered partially at one year following surgery. The results were comparable to primary arthroplasty in femoral neck fractures. THA is a useful salvage procedure for failed infected internal fixation of hip fractures. Extreme care must be taken to avoid fracture and penetration of femoral shaft in such cases. Auto graft, allograft and special components like multihole cup, narrow stem should be available for reconstruction in difficult cases.
Literature suggests in senile IT fracture group with osteoporosis and comminution, the rates of complications are very high. Documented figures show 16% deaths in non-operative treatment and 16% (late) non-union IT fractures in non operative treatment. The post fixation re-operation rate is 23% after two to three years. High rate implant cutout, penetration and plate cutout leads to increased morbidity and mortality again. The aim of this study is to find out the results of primary prosthetic replacement in comminuted, osteoporotic intertrochanteric fractures in elderly patients. Eight patients of the age group from 68 to 94 years (average 78.4) with four part fractures were operated primarily with bipolar hemiarthroplasty. They were operated by posterolateral approach and the hip joint was exposed through the fracture site itself. After pan release the proximal fragment was delivered and a modular locally manufactured cemented bipolar hemiarthroplasty was performed. Due care was taken to restore offset, limb length and soft tissue balancing. The patients were mobile early after two days with walker and they became independent within four weeks after operation. They were followed up from six months to 3.5 years (average 2.1 years). The functional and radiological evaluation was done. There were five females and three males. The modified Charnley score improved from average 2.3 pre-operatively to an average of 5.2 with respect to pain, mobility and function. All the patients were happy and independent. One patient developed abductor lurch, but managed to carry out independently all her activities of daily living. One patient had a dislocation. This lady was very unco-operative and never helped in the rehabilitation programme. She lost to follow-up. Radiologically, there were no signs of loosening, progressive adiolucent lines, subsidence or osteolysis at the latest follow-up. Primary prosthetic hemi-replacement in cases of osteoporotic four part fractures in elderly patients helps early restoration of function and thereby prevents complications.
