Clinical and functional outcome of total hip arthroplasty (cemented/ uncemented) in failed proximal femur fracture: A Prospective study

Abstract

Background: Since its introduction in the 1960s, THA has proved to be an excellent and reliable treatment procedure for the end stages of hip pathology, with satisfactory clinicaloutcomes. However, the long-term survival of a THA is a multifactorial issue and numerous factors are also important in survival. Despite successful outcomes, THA revision rates have grown steadily in recent years and has become a challenging concern among orthopedic surgeons. Aim: The present study was done to assess the clinical and radiological outcome of total hip arthroplasty in patients with failed neck of femur or intertrochanteric fractures.Methodology: Sixty patients, aged more than 18 years, who failed osteosynthesis of neck of femur or intertrochanteric fracture were included in the study. For all patients, we used the posterior approach (Moore’s). For all patients we noted the indication for re-operation. Functional assessment was done pre-operatively and immediate post- operatively using Harris Hip Score (HHS). Results: The most common indication for revision surgery was fracture of the neck of femur (58.3%) followed by Intertrochanteric fracture (35%). Pre-operative mean HHS score was 33.95 ± 9.57 which increased significantly to 89.25 ± 6.59 (p value < 0.001). All the patients had HHS score less than 60 pre-operatively. Post-operatively, it was observed that none of the patients had HHS of less than 60 and one patient had HHS of 60 to 69. HHS of 70 to 79 was observed in 11.7%, 30% had HHS of 80 to 89 and 56.7% had HHS of 90 to 100. Post-operative complications included varus deformity of the femur in 25%, nerve injury in 1.7%, superficial infection in 6.7%, anterior thigh pain in 5% and osteolysis in 3.3% Conclusion: It was found that the most common indication for revision THA was fracture neck of femur. Assessment with HHS pre- and post-operatively revealed significant improvement, in all subcomponents of HHS as well as the overall HHS