Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2018 Jan;33(1):144-148. doi: 10.1016/j.arth.2017.07.035. Epub 2017 Jul 29.
In situ screw fixation remains the most common treatment for minimally displaced femoral neck fractures (FNFs). Total hip arthroplasty (THA) can be used as a salvage procedure, but the results of conversion THA in this population have not been evaluated. The goals of this study were to evaluate (1) unique complications associated with conversion THA, (2) implant survivorship free of revision and reoperation, (3) radiographic results, and (4) clinical outcomes in patients undergoing conversion THA after in situ fixation of nondisplaced FNFs.
Between 2000 and 2014, 62 consecutive patients >65 years of age who underwent THA after in situ fixation of minimally displaced FNFs were identified. Indications were osteonecrosis (44%), post-traumatic/degenerative arthritis (35%), and nonunion (21%). Mean age was 78 years, and 73% patients were women. Mean follow-up was 5.5 years.
One patient was revised for aseptic femoral loosening at 11 years. One patient underwent debridement and modular component exchange at 10 years for acute hematogenous periprosthetic joint infection. Two patients underwent acute reoperation without component exchange (one superficial wound infection, one hematoma evacuation). Survivorship free of reoperation for any indication was 97% at 5 years. No patients with surviving implants had radiographic evidence of loosening at 5 years. Harris hip scores improved from 35-85 (P < .01) after THA.
Conversion THA was associated with clinical improvement, a low rate of complications, and excellent implant durability. Risks of loosening, dislocation, and periprosthetic fracture can be minimized with appropriate operative strategies and perioperative management.
对于轻度移位的股骨颈骨折（FNFs），原位螺钉固定仍然是最常见的治疗方法。全髋关节置换术（THA）可作为挽救性手术，但尚未评估该人群中转换 THA 的结果。本研究的目的是评估（1）与转换 THA 相关的独特并发症，（2）无翻修和再手术的假体存活率，（3）影像学结果以及（4）在原位固定非移位 FNF 后接受转换 THA 的患者的临床结果。
在 2000 年至 2014 年间，确定了 62 例接受过原位固定的轻度移位 FNF 后行 THA 的连续患者> 65 岁。适应证为骨坏死（44％），创伤后/退行性关节炎（35％）和骨不连（21％）。平均年龄为 78 岁，73％的患者为女性。平均随访时间为 5.5 年。
1 例患者在 11 年时因无菌性股骨松动而进行了翻修。1 例患者在 10 年时因急性血源性假体周围关节感染行了清创和模块化组件置换。2 例患者在没有更换组件的情况下进行了急性再手术（1 例浅表伤口感染，1 例血肿清除）。5 年时，任何原因均无再手术的生存率为 97％。在 5 年时，无存活植入物的患者有影像学松动的证据。THA 后 Harris 髋关节评分从 35-85 分提高（P <.01）。
转换 THA 与临床改善，并发症发生率低和假体耐用性好有关。通过适当的手术策略和围手术期管理，可以最大程度地降低松动，脱位和假体周围骨折的风险。
