Functional Outcomes in Failed Osteosynthesis of Proximal Femoral Fractures Managed by Total Hip Replacement Using the Modified Hardinge Approach: An Ambispective Cohort Study

Introduction Proximal femoral fractures are a major cause of disability, particularly in aging populations, with an increasing incidence. Although osteosynthesis remains the first-line treatment, failures are common due to various complications. Total hip arthroplasty (THA) is the preferred salvage procedure in such cases, despite its technical challenges. This study aims to evaluate functional outcomes following THA in patients with failed proximal femoral fracture fixation. Materials and methods This ambispective cohort study was conducted from 2022 to 2023 at King George's Medical University. Adult patients who underwent rescue THA for failed proximal femoral fixation were included. Clinical and radiological evaluations were performed preoperatively. All surgeries were performed under spinal anesthesia using a modified Hardinge approach. Postoperative functional outcomes were assessed using the Harris Hip Score (HHS) at follow-ups. Data were analyzed using descriptive statistics and appropriate inferential tests. Results A total of 39 patients (26 males, 13 females; mean age = 57.5 ± 9.9 years) were included, with most aged between 50 and 70 years. Fracture types included femoral neck (n = 21), intertrochanteric (n = 16), and subtrochanteric (n = 2). Common prior fixation methods included proximal femoral nail (33.3%), cannulated cancellous screws (25.6%), and dynamic hip screws (20.5%). The causes of failure included avascular necrosis (30.8%), backout (20.5%), non-union (17.9%), cut-out (12.8%), and secondary arthritis (17.9%). Patients underwent uncemented (41%), cemented (38.5%), or hybrid (20.5%) THA. Mean Harris Hip Scores improved significantly from preoperative (61.2 ± 10.3) to 6 weeks (74.1 ± 2.6), 1 month (82.5 ± 1.7), 6 months (88.0 ± 2.0), and 1 year (92.5 ± 1.1) postoperatively (p < .0001). Conclusion Total hip arthroplasty provides favorable functional outcomes in the management of failed osteosynthesis of proximal femoral fractures when guided by thorough preoperative planning and surgical expertise. The primary aim remains the restoration of hip biomechanics and facilitation of early mobilization. However, limitations such as small sample size and short follow-up duration warrant further multicentric studies for validating long-term outcomes.