Total Hip Replacement after Failed Internal Fixation of Trochanteric Femoral Fractures

Background: Failure of fixation of trochanteric fractures of the femur results in great disability and pain. Hip arthroplasty is a helpful reconstructive procedure in patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage. Objective: This prospective study is to evaluate clinically and radiologically, the early results of total hip arthroplasty in a group of patients with failed internal fixation of trochanteric femoral fractures. Patients and Methods: Total hip replacement was done for fifty patients with failed treatment of proximal femoral fractures, only forty two patients 29 males and 13 females completed the follow up and eight were lost. The procedure was carried out through a lateral exposure in all cases. Harris Hip Score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits. Results: The mean time of follow up was 42 months (range from 30-72 months). The mean Harris Hip Score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Thirty patients (72%) could freely walk outdoors using a cane or elbow crutch; eight patients (19%) had a limited walking ability using two axillary crutches, and four patients (9%) were able to walk indoors only. Conclusion: Total hip arthroplasty is an accepted procedure after failed internal fixation of trochanteric femoral fractures. Individualization of the implant selection according to patient age, level of activity, the bone stock of proximal femur, and the condition of the acetabulum.