AI Summary & Key Takeaways
AI InsightWhile themean HHS was 54.05±8.22 before THA, it was evaluated to be 86.45±8.73 at the last follow-up, which was a statistically significantdifference (p
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Abstract
BACKGROUND: This study is an investigation of the outcomes of salvage total hip arthroplasty (THA) to treat collum femorisfractures that resulted in complications or failure after osteosynthesis.METHODS: Twenty patients (6 male, 14 female; mean age: 56.7 years) who underwent salvage total hip arthroplasty (THA) between1988 and 2012 due to failure developing after closed reposition and osteosynthesis in the treatment of collum femoris fractures wereincluded in the study. The type of osteosynthesis, and the length of time until failure and before THA application after collum femorisfracture were recorded. Cementless acetabular and femoral components were used in all of the patients. Complications were definedas those occurring during and after surgery. The clinical results were assessed with the Harris Hip Score (HHS) and the presence ofloosening was assessed with radiological evaluation in follow-up.RESULTS: The mean length of the follow-up period was 59.4 months (range: 15–178 months). The collum femoris fractures of the20 patients were classified as: 5 Garden type II, 13 type III, 2 type IV, and 3 Pauwels type I, 8 type II, and 9 type III. Cannulated screwswere used in 13 patients (65%) and dynamic hip screw (DHS) fixation was used in 7 patients (35%). Complications observed afterosteosynthesis were nonunion in 4 cases (20%), malunion in 2 (10%), avascular necrosis in 10 (50%), and implant failure in 4 (20%). Amean of 9.66 months (range: 3–54 months) elapsed before osteosynthesis failure and the mean length of time until THA was 31.6±51.7months. There was no statistically significant difference between cannulated screw and DHS fixation in the development of complications (p=0.084). Early dislocation (5%), periprosthetic fracture (5%) and acetabular protrusion (5%) were recorded as complications.A revision was made upon determination of loosening in the 10th year in the patient who developed early dislocation. While themean HHS was 54.05±8.22 before THA, it was evaluated to be 86.45±8.73 at the last follow-up, which was a statistically significantdifference (p
Özet
AMAÇ: Bu çalışmada osteosentez sonrası komplikasyon gelişmiş veya başarısız olunmuş kollum femoris kırıklarının, kurtarıcı total kalça artroplastisi (TKA) ile tedavisinin sonuçları araştırıldı. GEREÇ VE YÖNTEM: 1988 ile 2012 yılları arası kollum femoris kırığı tedavisinde kapalı repozisyon ve osteosentez sonrası başarısızlık gelişen ve kurtarıcı TKA yapılan 20 hasta (6 erkek, 14 kadın; ortalama yaş: 56.7) çalışmaya alındı. Kollum femoris kırıkları sonrası osteosentez şekli, başarısızlık gelişme süresi ve TKA uygulama süreleri kaydedildi. Hastalara sementsiz femoral ve asetabuler komponent kullanıldı. Komplikasyonlar operasyon esnası ve sonrası olarak belirlendi. Son kontrolde Haris kalça skorlaması ile klinik sonuçlar ve çekilen grafiler ile gevşeme varlığı değerlendirildi. BULGULAR: Hastaların takip süreleri ortalama 59.4 (dağılım, 15–178) ay idi. TKA uygulanan 20 hastanın kollum femoris kırıklarının sınıflaması osteosentez sonrasında komplikasyonlar kaynamama 4 (%25), malunion 2 (%10), avasküler nekroz 9 (%45), implant yetersizliği 4 (%20) idi. Komplikasyonlar gelişmesinde kanüle vida ve DHS arasında istatistiksel anlamlı farklılık bulunmamakta idi (p=0.084). Komplikasyon olarak erken dislokasyon (%5), protez çevresi kırık (%5) ve asetabuler protrüzyon (%5) saptandı. Erken dislokasyon gelişen hastada 10. yılda gevşeme saptanması üzerine revizyon yapıldı. TKA öncesi HHS 54.05 iken son kontrolde 86.45 olarak değerlendirildi ve istatistiksel olarak aralarında anlamlı bir fark saptandı (p