Author(s): Dr. Harish Rajpurohit, Dr. Abhishek Jaroli, Dr. Hiren Bhalala and Dr. Gajanan Dhaked

Abstract: Failed surgical treatment of hip fractures presents a significant challenges in elderly osteoporotic population typically leads to profound functional disability and pain. Revision internal fixation and a salvage treatment with hip arthroplasty are two accepted treatment options. The purpose of this study was to assess the intra operative difficulties encountered and to evaluate the functional outcome of hip arthroplasty performed after failed internal fixation of intertrochanteric (IT) and fracture neck of femur (NOF). 20 patients with failed internal fixation (June 2012 to October 2013) were enrolled and operated during the study period. Functional assessment was done using the Harris Hip Score (HSS) and complications, if any, were documented. There were 11 cases (55%) with failed IT fracture and 9 cases (45%) of failed fixation of NOF fractures. Total hip replacement (THR) was performed in 13 patients (6 cemented and 7 uncemented) and bipolar hemiarthroplasty was done in 7 patients (4 cemented and 3 uncemented). The mean time interval to failure was 3.31 years (SD ± 3.17). The Harris hip score improved from preoperative 32.95 (SD ± 7.54) to 77.80 (SD ± 9.22) at final follow up which was significant (p < 0.001). Also the mean difference of improvement in preoperative Harris hip score and any postoperative score or between any two successive post-operative Harris hip scores was significant (P value <0.001).Complications were seen in 8 of 20 cases (7 I/T group and 1 NOF group). Mean HHS was higher in NOF group than I/T fracture group preoperatively as well as at final follow up (P value 0.003 preoperative and 0.013 postoperative). Our conclusion is that hip arthroplasty is an effective salvage procedure after failed fixation of proximal hip fractures despite the technical challenges and complications associated with it.

DOI: https://doi.org/10.33545/orthor.2021.v5.i1b.267