Management of Failed Fixation of Proximal Femur Fractures by Arthroplasty

Background: Fractures of the proximal femur are becoming more prevalent as the population ages. Failure of primary fixation of proximal femur fractures may occur in up to 9.6% of cases. Objective: To evaluate the clinical and functional outcome of conversion hip arthroplasty in patients with failure of osteosynthesis of proximal femoral fractures, surgical difficulties, and results. Patients and Methods: Thirty patients participated in a prospective case series with failed fixation of proximal femoral fractures. The age varied from 55 to 79 years old. Nine patients had neck and femur fractures. Twenty patients had trochanteric fractures, and one had a trochanteric fracture with subtrochanteric extension. The patients underwent surgery after an average interval period of 14.7 months in one stage in most cases. Various types of arthroplasty were used according to the specific condition of each case. Regular follow-up was done for each case, with a mean follow-up period of 26 months. Results: The clinical results were evaluated by HHS. The mean preoperative Harris hip score was 26.07 (6-47). The mean postoperative Harris hip score in the last follow up was 89.6 (60-98). We encountered in this study 4 cases had complications with total complications rate 13.3 %. Conclusion: Conversion hip arthroplasty is considered a salvage procedure for elderly patients after failure of fixation of proximal femoral fractures. Several technical difficulties are present in these cases. However, these difficulties could be dealt with by good preparation and evaluation of the patient clinically, in the laboratory, and radiologically. We showed a considerable improvement of the Harris Hip score (HHS) in all cases, and High patient satisfaction and good functional results were achieved..