Conversion Arthroplasty in Management of Failed DHS Trochanteric Fractures Fixation


The Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University


Abstract Background: Failed internal fixation of intertrochanteric (IT) hip fractures presents a significant challenge in the elderly, osteoporotic population. Conversion total hip arthroplasty (cTHA) and hemiarthroplasty (cHA) are both accepted salvage operations for failed IT fracture fixation, though limited clinical data exist regarding the optimal treatment between these procedures. Aim of Study: The aim of the present study was to provide adequate data that hip arthroplasty to salvage the failed internal fixation of failed intertrochanteric fractures. Patients and Methods: The present study was conducted on thirty two patients with failed DHS fixation of trochanteric fractures had been treated in Beni-Suef University Hospital, Beni-Suef Health Insurance Hospital and other private hospitals during the period from April 2013 to January 2015. All patients in the present study were evaluated for; fitness for surgery, measures to exclude infection and pathological fracture and musculoskeletal evaluation (The patients hip were evaluated clinically and radiologically both preoperatively and postop-eratively). Results: Patients'age ranged between 50-70 years old. The mean age was 60 years old. The entire mean scores preoperatively and at the last follow-up for all the 30 patients were summated. It showed an improvement of 60.87 points (from 13.79 to 74.66). Pre-operatively Harris hip scored ranged from 1.1 to 43 and ranged post-operatively from 54 to 94 points. This wide variation was due to the different patients' demographics, levels of activities and associated medical co-morbidities. Conclusion: Although hip arthroplasty to salvage the failed internal fixation of failed intertrochanteric fractures is a technically challenging procedure requiring experience, special instruments and implants, however, surprisingly it is associated with low orthopaedics complications and a high rate of patient's satisfaction and pain relief.