Outcome of Distal Fitting Revision Hemiarthroplasty in Failed Osteosyntheses of Trochanteric Fractures in Elderly – A Cross Sectional Retrospective Study

Abstract

Background: Treating failed internal fixation of intertrochanteric fractures are challenging due to patient factors and surgical hurdles which may include internal fixation or salvage arthroplasty (HA or THA). In our study we analysed the clinical and radiographic outcomes of 12 elderly failed osteosynthesis patients who were operated with a modular, uncemented long stem distal fitting  prosthesis as a salvage procedure. Methods: We did a cross sectional, retrospective, analytical study of patients who attended Orthopaedic outpatient department of Sunrise Hospital, Kerala, India between 2018 to 2020. We included only failed osteosyntheses patients with intertrochanteric fractures. The outcome was analysed by taking into account the increasing defects, bone remodelling in proximal femur & union, subsidence and stem fixation to bone in radiographs taken immediately postsurgery and comparing it on successive reviews.  Results: The mean age of the study participants and mean operation age of the index operation was 75 (12) and 74 years (range 62–87) respectively. The commonly encountered failure modes, following index surgery, were cut-out (n = 5), and femoral neck screw migration (n =4). We observed union among 10 cases, while restoration of proximal bone defects in 6, bony ingrowths in 7 and subsidence in 2 stems. Two patients were revised during the follow up period due to recurrent dislocation. Conclusion: The prosthesis used was advantageous as it allows fixation distal to the fracture system aiding restoration of proximal bone and soft tissue complex. Radiographic outcomes were satisfactory with minimal complications. Thus, the use of distal fitting modular bipolar prosthesis might prove to be effective in improving the morbidity and mortality in the elderly by assuring early weight bearing in failed fixation of intertrochantric fractures.