Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
J Orthop Traumatol. 2022 Jul 25;23(1):34. doi: 10.1186/s10195-022-00655-6.
Reoperations for secondary osteoarthritis, osteonecrosis, or hardware failure following failed internal fixation after intertrochanteric fracture (ITF) or femoral neck fracture (FNF) are common. An effective salvage treatment often involves complete removal of the hardware followed by total hip arthroplasty (THA). Almost no data are available regarding conversion to short-stem THA. This study aimed to evaluate clinical and radiological outcomes, potential complications, and the survival rate of short-stem THA following revision surgery.
We investigated 27 patients who underwent conversion THA using a calcar-guided short stem. Patient-reported outcome measurements were obtained, including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, as well as pain and satisfaction on the visual analogue scale. Radiological follow-up was also performed.
We identified 18 (66.7%) patients diagnosed with FNF and 9 (33.3%) patients with ITF. Clinical and radiological outcomes were satisfactory at the last follow-up (30.56 ± 11.62 months). One patient required early revision surgery due to dislocation and greater trochanter fracture. At the last follow-up, none of the short stems required revision. No other major complications occurred.
Given the low rate of complications and 100% survival, our findings indicate that short stems for conversion THA due to failed internal fixation may be considered an option in a properly selected patient population. However, it should not be considered a standard procedure and should only be performed by experienced surgeons.
转子间骨折（ITF）或股骨颈骨折（FNF）内固定失败后出现继发性骨关节炎、骨坏死或内固定失败，常需再次手术治疗。有效的挽救治疗方法通常包括彻底清除内固定物，然后进行全髋关节置换术（THA）。几乎没有关于转换为短柄 THA 的数据。本研究旨在评估翻修手术后采用卡尔卡导向短柄进行转换 THA 的临床和影像学结果、潜在并发症以及短柄 THA 的生存率。
我们调查了 27 例采用卡尔卡导向短柄行转换 THA 的患者。采用 Harris 髋关节评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及视觉模拟评分（VAS）评估患者报告的结果，包括疼痛和满意度。还进行了影像学随访。
我们发现 18 例（66.7%）患者诊断为 FNF，9 例（33.3%）患者为 ITF。末次随访时临床和影像学结果均满意（30.56±11.62 个月）。1 例患者因脱位和大转子骨折需要早期翻修手术。末次随访时，无短柄需要翻修。未发生其他重大并发症。
鉴于并发症发生率低和 100%的生存率，我们的研究结果表明，对于因内固定失败而进行的转换 THA，短柄可能是一种选择，适用于选择适当的患者人群。但是，不应将其视为标准程序，仅应由经验丰富的外科医生进行操作。
