Habib Zain, Malik Aditya, Moran Matthew, Rasool Muhammad Umer, Arifuzaman Mohammed, Ahmed Azeem, Mohan Rama
Trauma and Orthopaedics, Manchester University NHS Foundation Trust, Manchester, GBR.
Trauma and Orthopaedics, North Manchester General Hospital, Manchester, GBR.
Cureus. 2024 Nov 27;16(11):e74613. doi: 10.7759/cureus.74613. eCollection 2024 Nov.
Salvage arthroplasty for failed proximal femoral fracture fixation is a complex procedure. This involves the removal of the primary failed or broken implant followed by a hip joint replacement procedure. The complications and technical difficulties associated with these surgeries are often difficult to anticipate.
Initially, to further understand the position in the literature with regard to salvage arthroplasty, we completed an informative scoping review. Search terms were selected, and databases Embase and PubMed were utilised to form a literature search. Relevant articles were selected by two independent researchers, with a final list of nine studies reviewed and tabulated for themes to be identified and analysed. Subsequently, we retrospectively studied the notes of all the patients who underwent complex conversion arthroplasty in the same district hospitals in a span of 16 years (August 2002 to August 2018) and presented the results.
Seventy-one patients underwent complex salvage arthroplasty following a failed fixation of proximal femoral fracture under the care of three different surgeons. All surgeries were carried out by the posterior approach. The demographics, intraoperative events, and postoperative follow-up have been presented through clinical and radiological assessments. With a mean age being 73.6, female patients were almost twice the number of male patients. The left hip was the more common surgical site. Implant cutout was the most common cause of failure of the primary implant. Most of these surgeries were either uncemented (31 cases, 43.66%) or hybrid (29 cases, 40.84%). The most common acetabular size to be used was 50 mm, and the most common head size used was 32 mm. A majority of the surgeries were metal on poly bearings (64 cases, 90.14%). The mean surgical time, including anesthetic, was four hours and 13 minutes. A total of 31 (44%) patients needed blood transfusion postoperatively. The infection rate was 21.13% (15 cases), being the most common surgical complication. The mean follow-up of the patients was 27.2 months with the maximum follow-up being 125 months. The one-year mortality was found to be 14% (10 cases). The mean limb length discrepancy was shortening by an average of 3.84 mm. A total of 66.2% (47 cases) of patients were shortened postoperatively. The average cup abduction and anteversion angles were 35° and 24.25°, respectively. The average position of the femoral stem was 0.31° in the varus with 40.85% (29 cases) of patients having a slightly varus stem.
Upon drawing comparisons with primary hip arthroplasty for primary osteoarthritis through data available in the literature, it is obvious that salvage arthroplasty is a complex procedure with longer surgical times and onerous rehabilitation. Whilst it is not the same as revision arthroplasty, many of the characteristics in terms of surgical planning and outcomes are similar. Therefore, it is our recommendation that salvage hip arthroplasty procedures should be categorised, listed, and studied separately from primary arthroplasty in the National Joint Registry database.
针对股骨近端骨折内固定失败的挽救性关节成形术是一项复杂的手术。这需要移除初次失败或断裂的植入物，随后进行髋关节置换手术。这些手术相关的并发症和技术难题往往难以预料。
首先，为了进一步了解挽救性关节成形术在文献中的地位，我们完成了一项信息性范围综述。选择了检索词，并利用Embase和PubMed数据库进行文献检索。两名独立研究人员筛选出相关文章，最终列出九项研究进行综述并制成表格，以确定和分析其中的主题。随后，我们回顾性研究了在16年期间（2002年8月至2018年8月）在同一地区医院接受复杂转换关节成形术的所有患者的病历，并展示了结果。
71例患者在三位不同外科医生的治疗下，在股骨近端骨折内固定失败后接受了复杂的挽救性关节成形术。所有手术均采用后入路。通过临床和影像学评估呈现了患者的人口统计学特征、术中情况及术后随访结果。患者平均年龄为73.6岁，女性患者数量几乎是男性患者的两倍。左髋是更常见的手术部位。植入物穿出是初次植入物失败的最常见原因。这些手术大多采用非骨水泥型（31例，43.66%）或混合型（29例，40.84%）。最常用的髋臼尺寸为50毫米，最常用的股骨头尺寸为32毫米。大多数手术采用金属对聚乙烯衬垫（64例，90.14%）。包括麻醉时间在内，平均手术时间为4小时13分钟。共有31例（44%）患者术后需要输血。感染率为21.13%（15例），是最常见的手术并发症。患者平均随访时间为27.2个月，最长随访时间为125个月。发现一年死亡率为14%（10例）。平均肢体长度差异为平均缩短3.84毫米。共有66.2%（47例）患者术后肢体缩短。髋臼平均外展角和前倾角分别为35°和24.25°。股骨柄平均内翻角度为0.31°，40.85%（29例）患者的股骨柄略有内翻。
通过文献中的现有数据与原发性骨关节炎的初次髋关节置换术进行比较，很明显挽救性关节成形术是一项复杂的手术，手术时间更长且康复过程艰巨。虽然它与翻修关节成形术不同，但在手术规划和结果方面的许多特征是相似的。因此，我们建议在国家关节登记数据库中，挽救性髋关节成形术应与初次关节成形术分开分类、列出并进行研究。
