We describe a technique to salvage a painful hemiarthroplasty due to erosion of the acetabular cartilage in the absence of loosening of the femoral component. A press-fit metallic acetabular component which matched the femoral component was used as a metal-on-metal articulation. The procedure offered a shorter operation time with less blood loss and no risk of femoral fracture as might have occurred during conventional revision to a total hip replacement. The patient made an unremarkable recovery with a good outcome at follow-up of 15 months.

Fixation of extracapsular proximal femoral fractures with intra/extramedullary device is common operation in any trauma theatre. We audited our results of fixation of 307 similar fractures over the period of Feb’03 to Jan’06. Final analysis was on 252 cases (191 female and 61 male) with mean age of 86.7 years. The fractures were classified by AO classification (A1=116, A2=84, A3=52) and the implants used were DHS (204 cases) and Gamma nail (52 cases). Fixation failure was noted in 38 cases (15.07% failure rate). Failure incidence was higher in female patients and unstable fractures (A3). There was no difference in failure rate of DHS or Gamma nail fixation. The reasons identified for failures were inappropriate implant selection, inadequate reduction (p< 0.007), poor implant placement (screw head in anterior/superior quadrant p< 0.0029, TAD> 25mm p< 0.0037, oblique placement in relation to neck axis in lateral view). Multivariate logistic regression was used to identify the effect of each individual contributing factor. More than one factor was identified in all cases of failure. Out of 38 failures 3 patients died within 6 weeks after primary surgery, conservative treatment was done in 7 cases due to co-morbid conditions, 13 cases were treated by revised fixation, and 15 cases arthroplasty was carried out. The outcome after the second surgery was no different in revision fixation or arthroplasty. We conclude that failure of fixation of these fractures are serious event with disastrous consequences, so every effort should be made to produce a stable construct with any device during primary fixation.

Dynamic Hip Screw fixation for intertrochanteric fracture of femur is one of the most common operations in the trauma list of any DGH. The operation is commonly performed by the registrar or senior house officer as it is considered to be a relatively simple procedure. However the reality is slightly different as we audit our results of DHS fixation over a period of 2 years from May 2002 to August 2004. Out of 184 DHS fixation done during the abovementioned period, we identified 18 (10%) failures within 2–8 weeks postoperative period. We reviewed the pre-operative and post-operative X-rays to identify the possible reasons for failure. The reasons were inappropriate indication for DHS – 3 cases, inadequate fracture reduction – 6 cases, inappropriate implant placement −12 cases. 3 cases (16%) of failure had to be treated conservatively due to poor medical condition, 7 cases (39%) had the implant removed or revised and some type of arthroplasty was done in rest 8 cases (45%). Of the 15 cases treated operatively 12 had satisfactory outcome in terms of pain relief and movement and the rest 3 had residual pain, inadequate restoration of mobility affecting the quality of life. All patients had significant morbidity (prolonged hospital stay, depression) due to the failure of fixation and further operative procedures. Therefore we think appropriate guidance by experienced personnel is necessary for correct indication and meticulous operative technique.