CONVERSION TOTAL HIP ARTHROPLASTY FOR FAILED OSTEOSYNTHESIS OF SUBTROCHANTERIC FRACTURES

Introduction Subtrochanteric femur fractures (SFF) represent a significant challenge in orthopedic trauma surgery, resulting in fixation failures, mainly due to (medial or lateral) comminution and difficulty in restoring adequate alignment, despite modern intramedullary nailing techniques. The aim of this study is to evaluate clinical and radiological outcome when converting failed internal fixation to an uncemented hip arthroplasty with taper fluted stem. Materials and Methods A retrospective analysis was conducted on 15 patients (9f, 6m) with an average of 73 years, treated with intramedullary nail for osteosynthesis of SFF who subsequently underwent revision to total hip arthroplasty (THA) due to fixation failure. The proximal fracture fragment was reattached to the proximal femur using a trochanteric grip plate and a strut graft was added routinely. An uncemented taper fluted femoral stem and a dual mobilty cup was used in all cases. Results All patients achieved full weight-bearing within 6 weeks. At a mean f-up of 14 months, in all cases a radiological confirmation of bone union was evident; no cases of implant loosening, dislocation or infection were recorded. Two patients developed minor complications successfully managed with conservative treatment. According to PROMs, VAS and clinical scores, 73% of patients achieved a satisfactory result. Conclusions Arthroplasty following failed osteosynthesis of SFF should be considered a viable option in elderly: the present study shows satisfactory survival rate, functional outcomes and stable fixation. However, attention should be paid to increased operation time and blood loss. An uncemented taper fluted stem with a trochanteric grip plate and a strut graft facilitates early functional recovery and, with a dual mobilty cup, is nowadays our favourite choice.