Hip Arthroplasty After Failed Internal Fixation Of Intertrochanteric Fractures

Background: Hip arthroplasty after failed internal fixation of intertrochanteric fracture(FIF-ITF)is more complicated than primary hip replacement,and the selection of femoral stem remains controversial.The purpose of this study was to show the clinical efficacy of hip arthroplasty after FIF-ITF in multi centers,to compare the efficacy of different femoral stems and to investigate the treatment strategy of such patients.Methods: This study retrospectively included and analyzed the data of patients from several orthopedic centers in Fujian Province from 2010.12 to 2019.12 who underwent hip arthroplasty for FIF-ITF.Inclusion criteria: patients who were previously treated with internal fixation for ITF due to trauma,whose symptoms,signs and imaging examinations proved to be internal fixation failure and underwent hip arthroplasty;Exclusion criteria: patients <18 years old and followed up <1 year; patients with severe cardiovascular,cerebrovascular,liver,kidney and other organ or system diseases;abnormal mental state,or severe mental illness.Patients with tumors,important organ failure and other diseases that may affect the results of the study; patients who are unable to obtain detailed demographic data and physical and laboratory examination data related to the contents of this study.All patients were followed up at least once.Harris score,VAS score,ROM of hip joint and limb length difference(LLD)were used for clinical evaluation.Subjective questionnaire was used to investigate their satisfaction.Results: A total of 53 patients(24 males and 29 females)were included,37 cases were treated with PFNA,7 cases with DHS,8 cases with PF-ALP,and 1 case with cannulated screws.31 patients underwent total hip arthroplasty(THA)and 22 patients underwent hemiarthroplasty(HA).The mean age at the time of arthroplasty was 75.64± 11.58 years.The average operation time was 137.35(70-300)min and the average intraoperative blood loss was 575.39(200-1600)ml.There were 6 cases of iatrogenic periprosthetic fractures during the operation,including 1 case complicated with periprosthetic infection,and there were 1 case with distal screw hole fracture,2 cases with dislocation,and 1 case with bone cement leakage after operation.According to the length of the femoral stem,all patients were divided into standard stem group(n =20)and long stem group(n = 33).The operation time,intraoperative blood loss and incidence of intraoperative complications in the long stem group were higher than those in the standard stem group(P < 0.05).The average follow-up time was 44.11 ±30.39(12-120)months.There was no significant difference in Harris score,VAS score,ROM of hip and LLD between the two groups(P > 0.05).Conclusion: Hip arthroplasty is a reliable choice for the treatment of failed internal fixation after intertrochanteric fracture,but there is a certain incidence of complications.It is not necessary to use long stem in all cases,but the timing and length of long stem need to be further studied.