Shailendra Singh, D. Rastogi, Ahmad Ozair, S. Waliullah, S. Singh, R. Srivastava
{"title":"Total hip arthroplasty for failed osteosynthesis of proximal femoral fractures: Clinical outcomes from a low- and middle-income country","authors":"Shailendra Singh, D. Rastogi, Ahmad Ozair, S. Waliullah, S. Singh, R. Srivastava","doi":"10.4103/jajs.jajs_17_22","DOIUrl":null,"url":null,"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.","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arthroscopy and Joint Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/jajs.jajs_17_22","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
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.
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.