Total hip arthroplasty for complications of proximal femoral fractures.

OBJECTIVES: To determine problems associated with and to present the results of secondary total hip replacement for complications of proximal femoral fractures.

SETTING: An acute care hospital with a prospectively entered database for primary total hip arthroplasty.

PATIENTS AND PARTICIPANTS: The prospective database was reviewed to extract all patients undergoing primary total hip replacement for complications of treatment of proximal femoral fractures. These fifty-three patients were then compared with fifty-three patients from the same data bank matched for age, sex, weight, prosthesis type, and length of follow-up but who had not sustained a proximal femoral fracture before total hip replacement.

INTERVENTION: Primary total hip arthroplasty for complications of proximal femoral fractures. After the surgical procedure, patients were seen at follow-up intervals of three months and six months and, thereafter, yearly.

MAIN OUTCOME MEASUREMENTS: Patients were evaluated using the St. Michael's hip rating scale, which is a scale measuring pain, motion, and function specifically designed for evaluation of total hip arthroplasty. Routine radiographs were obtained at each patient visit.

RESULTS: The complications associated with total hip replacement in patients with previous proximal femoral fracture fixation occurred more frequently than in patients who had not had undergone previous fracture fixation; in addition, intraoperative surgical difficulty was significantly greater in those patients who had undergone previous surgery for hip fracture. However, the final hip score at > or = 2 years after total hip arthroplasty was not statistically different between the two patient groups.

CONCLUSION: Total hip replacement is a satisfactory salvage procedure for failed fracture treatment despite the increased incidence of operative difficulty and increased incidence of complication.