Results of revision surgery for hip hemiarthroplasties used to manage proximal femur fractures
Keywords:
Reoperation, Arthroplasty, Replacement, Hip, femoral fracturesAbstract
Introduction: Hip hemiarthroplasty as a surgical option for the management of proximal femoral fractures is a technique that has fallen into disuse. Nevertheless, hip hemiarthroplasty revision surgery has being increasing over time; therefore it is important to understand why hip hemiarthroplasties fail and how it happens, as well as how the revision surgery should be planned.
Methods: We performed a case series by including 24 patients (4 men and 20 women) who underwent a hip hemiarthroplasty revision surgery. Mean follow up after hip revision surgery was 36 months. All patients had received their hip hemiarthroplasty as a surgical treatment for proximal femur fractures by using a cemented monopolar Thompson prosthesis.
Results: Mean time for revision surgery after hip hemiarthroplasty was 3.7 years. The first cause for revision surgery was aseptic loosening of the femoral stem, followed by acetabular protrusio of the prosthesis. Most common femoral defects were Paprosky type II (18 patients), and type I acetabular defects (17 patients). Mean surgical time for revision surgery was 128.8 min. Mean blood loss was 868.8 ml. We presented two intraoperative femoral fractures that were managed with allograft and plate osteosyntesis.
Discussion: Hip monopolar Thompson type prosthesis survival time is shorter than what is usually presented in medical literature. Thompson prosthesis most often failed associated with a femoral defect. Therefore, hip hemiarthroplasty revision surgery is a demanding procedure, usually underestimated, that requires a surgical strict planning. Even though, this is only a case series, we do not longer recommend the use of monopolar hip arthroplasty for the treatment of proximal femur fractures, because its survival is too short and its revision surgery is highly demanding for the surgeon and a risky procedure for the patient.
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