Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures

Figures & data

Table 1. Baseline data for all patients included (n = 88)

	Mean (SD)
Age	83 (8)
Sex
Female	76
Male	12
Primary fracture type
Trochanteric	63
Subtrochanteric	25
Primary implant
Short Gamma nail	44
Sliding hip screw	30
Long Gamma nail	11
Medoff plate	3
Indication for prosthesis
Cutout	59
Nonunion	21
Femoral head necrosis	6
Posttraumatic osteoarthritis	1
Unacceptable implant position	1
Secondary prosthesis type
THA	63
Bipolar HA	18
Unipolar HA	7

THA: total hip arthroplasty;

HA: hemiarthroplasty.

Table 2. Secondary prostheses used for all patients who were operated upon using a THA (n = 63)

THA	n
Cemented Exeter ^a stem + cemented OGEE ^b cup for 28-mm head	47
Cemented Charnley ^b stem + cemented Charnley LPW ^b cup for 22-mm head	10
Cemented Lubinus SPII ^c stem + cemented OGEE ^b cup for 28-mm head	3
Uncemented Lubinus MP ^c stem + cemented OGEE ^b cup for 28-mm head	1
Cemented Exeter ^a stem + uncemented Trilogy ^d cup for 28-mm head	1
Cemented HNR ^a stem + cemented OGEE ^b cup for 28-mm head	1

^a Stryker Howmedica, Kalamazoo, MI.

^b DePuy/Johnson & Johnson, Warsaw, IN.

^c Waldemar LINK, Hamburg, Germany.

^d Zimmer, Warsaw, IN.

A. A 72-year-old women (patient 6) who was operated with a cemented Exeter THA with a standard-length femoral stem, and who sustained a periprosthetic femoral fracture. B. The same patient after reoperation with stem revision and plate osteosynthesis.

Table 3. Patients with reoperations of the secondary prosthesis (n = 14)

A	B	C	D	E	F	G	H	I
1	70	Male	T	SHS	Post traumatic osteoarthritis	THA	Deep infection	7 weeks. Debridement x 1. Later extraction of prosthesis
2	78	Male	T	SGN	Cut out	Bipolar HA	Deep infection	2 weeks. Debridement x 1
3	85	Female	S	LGN	Cutout	Bipolar HA	Deep infection	3 weeks. Debridement x 1
4	85	Female	T	SGN	Cutout	THA	Deep infection	3 weeks. Debridement x 3
5	87	Female	S	LGN	Nonunion	Unipolar HA	Deep infection	2 weeks. Debridement x 2
6	72	Female	T	SHS	Femoral head necrosis	THA	Periprosthetic fracture	253 weeks. Revision of femoral stem + plate osteosynthesis
7	80	Female	T	SGN	Cutout	THA	Periprosthetic fracture	63 weeks. Revision of femoral stem
8	80	Female	S	LGN	Nonunion	THA	Periprosthetic fracture	21 weeks. Plate osteosynthesis
9	81	Female	S	SGN	Cutout	THA	Periprosthetic fracture	56 weeks. Plate osteosynthesis
10	93	Female	T	SGN	Cutout	Unipolar HA	Periprosthetic fracture	8 weeks. Plate osteosynthesis
11	95	Female	T	SGN	Cutout	Bipolar HA	Periprosthetic fracture	23 weeks. Plate osteosynthesis
12	77	Female	T	SGN	Cutout	THA	Dislocation	3 weeks. Revision of femoral stem
13	84	Female	T	SGN	Nonunion	THA	Dislocation	3 weeks. Closed reduction x 1
14	86	Male	T	SHS	Nonunion	THA	Dislocation	5 weeks. Closed reduction x 1

A Patient

B Age

C Sex

D Primary fracture type

S: Subtrochanteric

T: Trochanteric

E Primary implant

SHS: sliding hip screw;

SGN; short Gamma nail;

LGN: long Gamma nail;

F Indication for secondary prosthesis

G Secondary prosthesis type

THA: total hip arthroplasty;

HA: hemiarthroplasty.

H Indication for reoperation of secondary prosthesis

I Time to reoperation and history

Table 4. Baseline data in relation to the occurrence of reoperation

	No reoperation	Reoperation	p-value	Cox regression	p-value
	(n = 74)	(n = 14)		HR (95% CI)
Primary fracture type
Trochanteric	53	10		1 ^c
Subtrochanteric	21	4	1.0	1.2 (0.3–4.5)	0.8
Primary implant type
Intramedullary nail ^a	44	11		1 ^c
Plate ^b	30	3	0.2	0.4 (0.1–1.4)	0.1
Secondary prosthesis type
THA	54	9		1 ^c
HA	20	5	0.5	1.7 (0.5–5.2)	0.4
Femoral stem length
Long stem	38	3		1 ^c
Standard length	36	11	0.05	3.6 (1.0–13)	0.06
Surgical approach
Anterolateral	44	9		1 ^c
Posterolateral	30	5	1.0	0.8 (0.3–2.7)	0.8

^a includes short and long Gamma nails.

^b includes sliding hip screw and Medoff plates.

^c reference.