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Purpose of this study was to evaluate the outcomes of patients underwent hemiarthroplasty for proximal femoral fracture converted to total hip arthroplasty (THA).
A total of 138 patients from October 2009 till October 2014 had conversion of their failed hemiarthroplasties following a proximal femoral fracture to total hip arthroplasty (THA) in Erfa...
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Context 1
... main indications for conversion arthroplasty were stem loosening in 75 patients (54.4%) ( Fig. 3) and acetabular erosion in 66 patients (47.7%); there were also 12 patients (8.6%) with an unreduced dislocation (Fig. 4); 9 patients (6.5%) with femoral erosion and 6 patients (4.3%) with protrusion (Fig. 2). The mean time from primary operation to appearance of symptoms in patients with alone stem loosing was 41 months (range 6-108 months), 57 months for alone acetabular erosion (range 18-108 months), 34 months for combination of acetabular erosion and stem loosening (range 6-96 months), 15 months for dislocated hemiarthroplasty (range 6-24 months), and 96 months for femoral erosion (range 96-96 ...
Context 2
... patients (7.24%) had infection. The mean preoperative HHS score was 44.93 ? 8.40 in patients (ranged 30-62). The average of shortening was 1.79 ? 1.11 preoperatively in patients (ranged 0-5). Thirty-three patients (23.80%) had acetabular deficiency (23 patients Paprosky type 1 (69.6%) and 10 patients Paprosky type2 (30.4%)) and 6 patients were managed with femoral bulk allograft; 6 patients with PE cemented; 12 of them with central IM Augment and 9 patients with reflection cup (Fig. 2). Fractures of the femur and trochanteric avulsion were treated by cerclage wiring and weight bearing was delayed for 3 months in patients with intraoperative ...
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Background:
The Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term...
Purpose:
To evaluate the clinical and radiographic mid-term results of short-stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH).
Methods:
We reviewed 83 cases that underwent Metha stem between November 2010 and November 2012. The appearance of bone trabeculae development and radiolucent line were reviewed...
Purpose
Displaced femoral neck fractures (FNF) usually require surgical treatment with either a total hip arthroplasty (THA), unipolar hemiarthroplasty (U-HHA), or bipolar hemiarthroplasty (B-HHA). However, there is still controversy regarding the optimal implant. This network meta-analysis compared the outcomes and complication rates of THA versus...
Citations
... increasing to 95.41±2.27 at the final follow-up assessment. During the course of the study, dislocation was observed in 6 patients, constituting 4.34% of the cases [12] . ...
... The reported rates of PJI after hip arthroplasty for hip fractures vary between 0 and 18% with an average PJI rate of 2-4% [11,12]. The poor medical status of patients with older age increases associated comorbidity factors, and surgery performed for a hip fracture associated with a fracture hematoma increases the risk of PJI. ...
Introduction:
The overall complication rate after proximal femur fracture surgery is high. This study aims to define the reoperation reasons and outcomes of reoperations after proximal femur fracture surgery in elderly patients.
Methods:
This retrospective cohort study included patients over 75 years of age who underwent surgery for an intertrochanteric femur fracture and femoral neck fracture between 2014 and 2021. The minimum follow-up was 12 months, or until the patient was deceased. The primary outcome measure was the success of reoperation with regard to fracture type and implant. Results: A total of 89 patients required reoperation for an overall rate of 9.3% during follow-up. Infection was the leading reason for reoperation. Hemiarthroplasty (HA) for intertrochanteric fracture is associated with a high rate of infection compared with HA for femoral neck fracture. The success rate of reoperation due to postoperative infection was poor (46.3%) whereas the success rate for other implant-related complications was favorable (91.6%). Conclusion: The risk of postoperative infection after HA is significantly higher for intertrochanteric femur fractures compared to neck fractures in the elderly population. The limited success after postoperative infection should be taken into consideration in decision-making.
... [2][3][4][5][6] The most used technique for management of infections is staged re-implantation of prosthesis after systemic antibiotic therapy. [7] Despite of lower rate of infection after primary THA (<1%), [2,5,6,[8][9][10][11] the rate of infection after 2-step THA is reported between 3.2% and 13%. [12][13][14][15] Recent guidelines have mentioned the improvement in diagnostic approaches of pre-operative infections. ...
Infection is a major threatening side effect after total hip arthroplasty (THA) that its management is so difficult and is accompanied by different complications. The aim of this study was to determine the outcomes of patients underwent 2-staged THA after a course of antibiotic therapy. It was an observational prospective study performed during 2009 and 2019. We managed 51 patients with infected THA using a method in which antibiotic prophylaxis was performed after THA. We followed the same protocol for treatment of patients included 2-staged revision: in first stage, removal of infected instruments were performed and insertion of a hand-made antibiotic-cement spacer was done until erythrocyte sedimentation rate and CRP were normalized. In second stage, an un-cemented prosthesis was re-implanted in femoral side and post-operative IV antibiotic were administered for a week. Patients were monitored for about 15 months. Data were analyzed. There were 3 patients developed recurrent infection required girdlestone due to the aging. One of them needed to remove implant and 2 other with 3 times of re-infection were treated by antibiotic therapy. Other 10 cases were treated first by re-changing the cement. The rate of successful treatment was 78.4% (40 of 51) after the primary surgery and antibiotic therapy. This rose to 92.1% (47 of 51) following more debridement and antibiotic therapy. The merging of staged surgical debridement, using spacer of cement-antibiotic and re-implant beside 1-week intravenous antibiotic therapy, leaded to appropriate early outcomes in this series.
... Thus, the femoral canal will be filled with cement and then implant will be inserted, after a while it will be fixed in its place. [2][3][4][5] These patients can soon put their weight on the member and with a physiotherapy session (almost immediately after the surgery) walk without any help. ...
Acetabular revision arthroplasty with major bone loss is one of the most difficult operations in hip arthroplasty, The graft augmentation prosthesis (GAP) has been designed particularly as an implant for revision acetabular reconstruction. We evaluated the use of GAP II acetabular cage in revision of acetabulum in total hip arthroplasty. From 2009 to 2014, we performed revision total hip arthroplasty in patients with acetabular defects by cage (GAP II) in patients referred to Milad and Erfan Hospitals, Tehran, Iran. We included all patients in class 3a and 3b of Paprosky bone loss classification and type III bone loss according to the system of the American Academy of Orthopedic Surgeons. We used SPSS software Ver 19 and descriptive tests, Chi square and independent t-test were used for analysis. There were 221 men (71.99%) and 86 women (28.01%) with an average age of 51.3 ± 21.7 years (range, 35–86 years). The Modified Harris Hip Score (MHHS) improved significantly at the last follow-up compared with the preoperative MHHS (P < .001). The mean MHHS was 40 (range, 29–44) preoperatively and 92 (range, 86–95) at the last follow-up. There were no major intraoperative complications during acetabular reconstruction. Our findings showed that using GAP II acetabular cage in the restoration of acetabulum in hip revision surgery is significantly desirable.
... In his stuady he found that the less favorable results associated with revision THA were only partly explained by the greater morbidity and older age. In Afshin Taheriazam et al. [12] suggest good functional outcome after revision hip arthroplasty and due to less duration of study period, small sample size and also we found that aseptic loosening was the most common indication for revision. ...
... However, conversion to THA for failed AMH may be more challenging and should be done with great care to prevent intraoperative complications. 13 Although the best method for managing femoral neck fractures in the elderly is considered THA, it is not the primary modality in developing countries like Pakistan. Here, cost-effectiveness becomes dominant over the risk vs. benefit theory. ...
Objective: To analyze the functional outcome of conversion total hip arthroplasty (THA) using Harris hip score and evaluate intraoperative difficulties faced during conversion to THA. Methodology: This prospective study evaluated five-year outcome of THA in patients with failed Austin Moore hemiarthroplasty (AMH). From June 2014 to November 2020 (by a nonrandom consecutive sampling technique), all patients who had AMH were evaluated and those with failed procedures were sorted out. We selected patients for THA who were followed up for five years. Harris Hip Scores (HHS) was calculated for the functional outcomes. Results: Out of 28 patients, 16 (57.14%) were females and 12 (42.86%) males. Mean age was 61.1 ± 3.3 years. Excluding two patients who died (due to systemic causes), HHS evaluation at one year15 (53.6%) showed excellent, 9 (32.1%) good, one (3.6%) fair and one (53.6%) poor result. After 5-years, 6 (21.4%) showed excellent 18 (64.3%) good, one (3.6%) fair, and one (3.6%) poor result. The mean HHS was 84.7 ± 6.7 at the last follow-up. Conclusion: THA after failed AMH is an excellent treatment strategy to control pain and restore function.
... Previous studies have demonstrated improved WOMAC and Harris Hip Scores after cTHA from failed bipolar hemiarthroplasty as well as conversion from failed CMN, despite relatively high short-term complication rates. 9,17,27 Additionally, Tadevich et al. evaluated a matched cohort of cTHA and pTHA patients and found that UCLA activity level scores between the two groups were similar at one year follow-up. 15 These reports support the findings of the present study, suggesting that cTHA leads to acceptable patient outcomes. ...
Background:
Conversion total hip arthroplasty (cTHA) is increasingly utilized as a salvage procedure for complications associated with fracture fixation around the hip and acetabulum and for failed hip preservation surgery. While primary THA (pTHA) has a high success rate, little is known about outcomes following conversion THA. The purpose of this study is to evaluate patient reported outcomes (PROs) and complication rates following conversion THA compared to primary THA.
Methods:
Patients that underwent cTHA or pTHA from 2015-2020 at a large tertiary referral academic center were retrospectively identified. THA patients were propensity matched in a 1:1 fashion by age, body mass index (BMI), and sex. Pain scores and PROMIS physical function (PF), pain interference (PI), and depression (DA) scores were compared at preoperative and final postoperative follow up timepoints using independent t-tests. Differences in complication and reoperation rates between cohorts were assessed using chi square analysis.
Results:
A total of 118 THAs (59 cTHA, 59 pTHA) were included in this analysis with an average follow up of 21.3 months. cTHAs were most commonly performed following hip fracture fixation (50.8%). The conversion cohort had significantly longer lengths of stay (3.6 days vs 1.9 days, p<0.01) and greater use of revision-type implants (39.0% vs 0.0%, p<0.01) compared to pTHA. There was no significant difference in complication rates (cTHA = 15.3%, pTHA = 8.5%; p=0.26), with intraoperative fracture being the most common for both. Primary and conversion THA groups also experienced similar reoperation rates (cTHA = 5.1%, pTHA = 6.8%; p=0.70). No significant differences in PROs at final follow up were identified between groups.
Conclusion:
Patients undergoing cTHA required increased utilization of revision hip implants and had longer lengths of stay, but had comparable complication and reoperation rates, and ultimately demonstrated similar improvements in PROMIS scores compared to a matched cohort of pTHA patients. Level of Evidence: III.
... 12 With the development of acetabular arthritis, conversion of HA to THA is commonly performed for pain relief to remove the articular bearing against the metal prosthetic femoral head. [13][14][15] Compared to primary THA, HA conversion to THA has been associated with higher rates of reoperations and complications. [16][17][18][19] Studies demonstrating matched cohorts have involved conversions done for all failed hip fractures, including those receiving cephalomedullary nails, percutaneous screw fixation, and sliding hip screws. ...
Background:
One of the most common surgical options for treatment of a femoral neck fracture is hemiarthroplasty (HA). However, progression of arthritis or pain can necessitate conversion to total hip arthroplasty (THA). While conversion to a THA is a viable option, it does carry multiple risks. The purpose of this study was to identify whether performing conversion from HA to THA carries an increased risk of post-operative joint complications when compared to elective THA.
Methods:
An administrative claims database was queried to identify patients who underwent conversion from a HA to a THA. Incidences of prosthetic dislocation, prosthetic joint infection (PJI), periprosthetic fracture, aseptic loosening, and revision were collected and compared to elective primary THA with multivariable logistic regression.
Results:
Patients undergoing conversion THA had significantly higher risks of all joint complications examined at both 1 and 2 years after surgery. These included prosthetic dislocation (1-year: OR 2.95; 2 years: OR 3.77), PJI (1-year: OR 1.38; 2 years: OR 2.13), periprosthetic fracture (1-year: OR 2.95; 2 years: OR 3.75), aseptic loosening (1-year: OR 6.86; 2 years: OR 7.70), and revision (1-year: OR 3.65; 2 years: OR 6.73).
Conclusion:
Performing conversion arthroplasty from HA to THA is associated with an increased risk of multiple joint complications in both the short and mid-term follow-up period. Surgeons should consider these complications when indicating HA for femoral neck fractures and elective conversion arthroplasty.
... Acetabular erosion and stem loosening have been reported to be two most common causes of failure after a HA procedure. The mean time from index surgery to those symptomatic failures ranged from 34 to 96 months [29]. A modern generation of DM-THA has been reported with excellent long-term implant survival (more than 95% at 10-year follow-up) [30]. ...
Background:
Elderly patients with femoral neck fractures are at a higher risk of dislocation after hip arthroplasty procedures. In comparison with total hip arthroplasty (THA), bipolar hemiarthroplasty (HA) and dual-mobility total hip arthroplasty (DM-THA) can be an effective alternative treatment which increases the effective head size and overall stability of the prosthesis. We aim to review the current evidence on the outcome after DM-THA and HA for femoral neck fractures in the elderly.
Methods:
We performed a comprehensive review of literatures on PubMed, Embase, Web of Science and the Cochrane Library for randomized controlled trials and comparative interventional studies. Of the 936 studies identified, 8 met the inclusion criteria (541 DM-THA and 603 HA procedures). Two reviewers independently reviewed and graded each study and recorded relevant data including dislocation rate, implant failure rate, reoperation rate, one-year mortality rate, Harris hip score (HHS), operation time and intraoperative blood loss.
Results:
DM-THA was associated with a lower dislocation rate (OR: 3.599; 95% CI 1.954 to 6.630), a lower reoperation rate (OR: 2.056; 95% CI 1.211 to 3.490), an increased operation time (SMD: -0.561; 95% CI -0.795 to -0.326) and more intraoperative blood loss (SMD: -0.778; 95% CI -1.238 to -0.319), compared with the HA group. Moreover, the multivariate regression analysis revealed that age, female sex, posterolateral surgical approach, choice of DM-THA or HA were not associated with dislocation or reoperation.
Conclusions:
Based on the current evidence, the advantages reported for DM-THA over HA with regards to dislocation and reoperation rate in elderly patients with FNF remain inconclusive. High-quality studies on the high-risk patients with cognitive disorder or dementia are necessary to validate the value of DM-THA.
... These advantages of HA ostensibly make it a superior treatment for older adults with various underlying comorbidities [1,5]. Some concerns in relation to HA have been discussed in other studies: The reoperation rate for failed HA is reportedly as high as 24%, and the problem of acetabular wear has been noted as the primary cause of HA failure [11][12][13][14][15]. These concerns might provide additional motivation for the recommendation of primary THR for FNF displacement. ...
Background
Femoral neck fracture (FNF) is among the commonest fractures affecting the geriatric population. Hemiarthroplasty (HA) is a standard treatment procedure and has been performed by hip surgeons for decades. Recently, primary total hip replacement has proved advantageous for the treatment of such fractures.
The aim of this study is to retrospectively review all causes of failure of all patients who underwent HA in our institute and reevaluated whether HA remains a favourable choice of treatment for patients with displaced FNFs.
Methods
A total of 4516 patients underwent HA at our centre from 1998 to 2017. The HA implants included unipolar and bipolar prostheses. Patients diagnosed with displaced FNF, underwent primary HA initially, required second revision procedures, and followed up for a minimum of 36 months were included in this study. Data were collected and comprehensively analysed.
Results
In 4516 cases, 99 patients underwent second surgeries. The revision rate was 2.19%. Reasons for failure were acetabular wear (n = 30, 30.3%), femoral stem subsidence (n = 24, 24.2%), periprosthetic fracture (n = 22, 22.2%), infection (n = 16, 16.2%), and recurrent dislocation (n = 7, 7.1%). The mean follow-up period was 78.1 months. The interval between failed HA and revision surgery was 22.8 months.
Conclusion
HA has a low revision rate and remains a favourable choice of treatment for patients with displaced FNFs.
