Complex Hip Arthroplasty Following Failed Proximal Femur Osteosynthesis

Background: Hip fractures are common, especially in the elderly population, and orthopaedic surgeons frequently face many technical difficulties in their surgical management. It is commonly known that proximal femur fractures can result in failed osteosynthesis, which can be characterized by non-union, loss of reduction, or implant loosening. If osteosynthesis is unsuccessful for any reason, the next step in management is likely a complex hip replacement procedure. We hope to advance the current knowledge base and assist in the management of this difficult patient population. Methods: This retrospective study included 64 patients who underwent complex hip arthroplasty after failed osteosynthesis for proximal femur fractures initially treated with Open Reduction and Internal Fixation (ORIF) from January 2017 to December 2021 using the non-probability Convenience Sampling technique.Data from Dr. Ziauddin Hospital's electronic records were analyzed for functional and radiographic outcomes up to one-year post-surgery. The Fisher exact test was used for contingency tables, and data was calculated via SPSS version 23, P < 0.05 was considered significant. Results: Of the 64 patients, 24 were male (37.5%) and 40 females (62.5%). Initial fractures included 26 subtrochanteric (40.6%) and 38 intertrochanteric (59.4%), treated with Proximal Femoral Nail (37.5%), Recon Nail (12.5%), or Dynamic Hip Screw (50%). Failure reasons were cut-outs (59.3%) and non-unions (40.6%). Pre-operatively, most patients had poor or fair Harris Hip Scores (HHS). Post-revision, 62 patients (96.8%) underwent cementless THA, and 2 (3.2%) cemented THA, with significant HHS improvement: 78% scored good, 18.8% excellent, and 3.2% fair. Conclusion: This study confirmed the efficacy of complex hip arthroplasty for failed osteosynthesis with good radio-clinical outcomes.