Total hip arthroplasty for failed osteosynthesis of proximal femoral fractures: Clinical outcomes from a low- and middle-income country

Q4 Medicine
Shailendra Singh, D. Rastogi, Ahmad Ozair, S. Waliullah, S. Singh, R. Srivastava
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引用次数: 0

Abstract

Introduction: Total hip arthroplasty (THA) has a demonstrated utility in the surgical management of patients with proximal femoral fractures that fail internal fixation, with good outcomes reported from high-income countries. Given the lack of data from resource-limited settings, this work sought to report the clinical outcomes of THA for failed proximal femoral osteosynthesis from a low- and middle-income country (LMIC). Methods: The work was conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A retrospective cohort study was carried out on all patients who underwent rescue THA for failed osteosynthesis of proximal femoral fractures, from January 2016 to June 2020, at a tertiary care center in Northern India. Primary study outcomes were functional outcomes as assessed by Harris Hip Score (HHS) at 1-year postoperatively and the frequency of perioperative complication as assessed by Clavien-Dindo-Sink Grading System. Results: Twenty-eight patients with mean age of 43.25 ± 10.5 years were included, with 18 males and 10 females. For their femur fracture stabilization, the most common method used had been dynamic hip screw (n = 16, 57.1%), followed by cannulated cancellous screw (n = 6, 21.5%), proximal femoral nail (n = 3, 10.7%), dynamic condylar screw (n = 2, 7.1%), and Schanz Screw (n = 1, 3.6%). Causes of failure had included cut-out of screw (n = 14, 50.0%), avascular necrosis (n = 8, 28.6%), back-out of screw (n = 3, 10.7%), non-union (n = 2, 7.1%), and secondary osteoarthritis (n = 1, 3.6%). THA was carried out after mean 26.64 ± 9.01 months after index procedure. HHS improved significantly from 39.71 ± 10.89 preoperatively to 79.54 ± 4.22 at 1-year follow-up (mean difference 39.82, 95% confidence interval 43.66–35.98, P < 0.001). Perioperative complications occurred in two patients of Clavien-Dindo-Sink Grade III and another of Grade II, with no mortality occurring by 1 year. Conclusions: In resource-limited settings like LMICs, THA may be a safe and efficacious surgical modality for failed osteosynthesis of proximal femoral fractures.
全髋关节置换术治疗股骨近端骨折成骨失败:来自中低收入国家的临床结果
引言:全髋关节置换术(THA)在股骨近端骨折内固定失败患者的外科治疗中具有显著的实用性,高收入国家报告了良好的疗效。鉴于缺乏来自资源有限环境的数据,这项工作试图报告来自中低收入国家(LMIC)的THA治疗股骨近端骨合成失败的临床结果。方法:这项工作是根据加强流行病学观察研究报告(STROBE)指南进行和报告的。对2016年1月至2020年6月在印度北部一家三级护理中心因股骨近端骨折骨合成失败而接受抢救性THA的所有患者进行了回顾性队列研究。主要研究结果是术后1年通过Harris髋关节评分(HHS)评估的功能结果,以及通过Clavien-Dindo Sink评分系统评估的围手术期并发症发生率。结果:28例患者平均年龄为43.25±10.5岁,其中男性18例,女性10例。对于股骨骨折的稳定,最常见的方法是动力髋螺钉(n=1657.1%),其次是空心松质螺钉(n=621.5%)、股骨近端钉(n=310.7%)、动力髁螺钉(n=217.1%)和Schanz螺钉(n=136.6%),术后平均26.64±9.01个月进行THA。HHS从术前的39.71±10.89显著改善到1年随访时的79.54±4.22(平均差异39.82,95%置信区间43.66–35.98,P<0.001)。两名Clavien-Dindo Sink III级患者和另一名II级患者出现围手术期并发症,1年内无死亡。结论:在资源有限的情况下,如LMIC,THA可能是治疗股骨近端骨折骨合成失败的一种安全有效的手术方式。
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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
自引率
0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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