Conversion arthroplasty in management of failed DHS trochanteric fractures fixation / Mohammad Sayed Saleh Mohammad ; Supervised Alaa Eldin Mohee Soliman , Ahmed Mahmoud Attiat Allah , Emad Gaber Kamel Elbanna

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopaedic Surgery

Hip arthroplasty after failed treatment of an intertrochanteric fracture is a technically challenging procedure. Its difficulty is due to several factors including; poor bone quality, bone loss and articular cartilage damage. The purpose of the present study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. Methods between April 2013 and June 2015, a prospective study was undertaken including thirty-two patients (24 females and 8 males) with a mean age 61.9 years old(range; 50 - 70 years old). Two patients were lost in less than 3 months period and the remaining 30 patients were followed up for a mean of 12 months (range; 3 - 25 months) after surgery.All patients had a conversion hip arthroplasty. THA was used in 18 hips, 12 Bipolar cementless in 12 cases and reversed hybrid in one patient. A calcar replacement designor long-stem implant was used in 2 of the 32 hips. Results At the time of the last follow-up, our mean Harris hip score has showed an improvement of 60.87 points (from 13.79 to 74.66). Pre - operatively Harris hip scored ranged from 1.1 to 43 and ranged post-operatively from 54 to 94 points. This wide variation was due to the different patients' demographics, levels of activities and associated medical co-morbidities. We found statistically significant relation between the patient age (p - value 0.001) and body mass index (p-value 0.00) and the outcome. No statistically significant relationship was found between the number of previous surgeries (p- value 0.57) and type of the original fracture (p - value 0.13) and the outcome. Conversion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture. Although technically challenging and need experience, few serious orthopaedic complications were detected in our study. It is results in good functional outcome, pain relief and high patient satisfaction. Level of Evidence Therapeutic study, Level IV case series no, or historical, control group

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