Total Hip Arthroplasty Following Failed Internal Fixation of Hip Fractures: Clinical and Radiological Outcomes in a Retrospective Study of 14 Cases

Abstract

Background: Total hip arthroplasty (THA) is the reference salvage procedure for failed internal fixation of hip fractures. This revision surgery is technically demanding and carries a higher complication rate than primary THA. Aim: The aim of this retrospective study was to evaluate clinical and radiological outcomes at short-to-medium term follow-up. Methods: A retrospective single-center study including 14 patients who underwent THA after failed internal fixation of femoral neck, trochanteric or acetabular fractures (June 2017 – January 2021) at Mohamed V Hospital, Tangier. The mean follow-up was 18 months. Functional assessment was performed using the Postel-Merle d'Aubigné (PMA) score. Results: The patient’s mean age was 63 years Old; the mean operative time was 130 minutes. Six patients required blood transfusion. One intraoperative complication occurred (periprosthetic fracture, 7%). No postoperative dislocation or deep infection was recorded. The radiological outcomes were satisfying, 93% of acetabular cups were correctly positioned within the 40–45° inclination range Heterotopic ossification was observed in 2 patients (14.3%). Excellent PMA score was achieved in 71.5% of patients. Our results, consistent with the international literature, confirm that conversion THA is the only reliable salvage option for failed hip fracture fixation, permitting restoration of ambulatory capacity and pain relief. Conclusion: THA after failed hip fracture fixation is a technically challenging but effective salvage procedure. With adequate preoperative planning and appropriate implant selection, it allows restoration of hip function in the vast majority of patients and should be considered the only valid salvage option over re-osteosynthesis.