Total hip arthroplasty for complications of proximal femoral fractures.

OBJECTIVES

To determine problems associated with and to present the results of secondary total hip replacement for complications of proximal femoral fractures.

SETTING

An acute care hospital with a prospectively entered database for primary total hip arthroplasty.

PATIENTS AND

PARTICIPANTS

The prospective database was reviewed to extract all patients undergoing primary total hip replacement for complications of treatment of proximal femoral fractures. These fifty-three patients were then compared with fifty-three patients from the same data bank matched for age, sex, weight, prosthesis type, and length of follow-up but who had not sustained a proximal femoral fracture before total hip replacement.

INTERVENTION: Primary total hip arthroplasty for complications of proximal femoral fractures. After the surgical procedure, patients were seen at follow-up intervals of three months and six months and, thereafter, yearly.

MAIN OUTCOME MEASUREMENTS: Patients were evaluated using the St. Michael's hip rating scale, which is a scale measuring pain, motion, and function specifically designed for evaluation of total hip arthroplasty. Routine radiographs were obtained at each patient visit.

RESULTS

The complications associated with total hip replacement in patients with previous proximal femoral fracture fixation occurred more frequently than in patients who had not had undergone previous fracture fixation; in addition, intraoperative surgical difficulty was significantly greater in those patients who had undergone previous surgery for hip fracture. However, the final hip score at > or = 2 years after total hip arthroplasty was not statistically different between the two patient groups.

CONCLUSION

Total hip replacement is a satisfactory salvage procedure for failed fracture treatment despite the increased incidence of operative difficulty and increased incidence of complication.