Results of total hip arthroplasty after foiled internal fixation of hip fractures.

Objective: Treatment of fractures of the proximal femur by open reduction a nd internal fixation is prone to complications and frequently requiring sec ondary joint replacement. The aim of the present study was to examine the r esults-of total hip arthroplasty as a salvage procedure for failed internal fixation of femoral or acetabular fractures. Patients and methods: We retr ospectively studied 145 patients who had undergone 146 total hip arthroplas ties for failed internal fixation of femoral (n=135) or acetabular fracture s (n=11). Mean follow-up time after insertion of the hip endoprosthesis was 7.1 years (1.5-14.7 years). Patient evaluation included a history, clinica l examination, and standard radiographs. Results: Twenty-eight patients had died, and 18 patients were lost to follow-up. Kaplan-Meier analysis with r evision of the implants as the:end-point demonstrated 85 percent survival a fter ten years. Using the Merle d'Aubigne rating system, we found good br e xcellent results in 85 percent of the cases. However, only 73.9 percent of the patients were satisfied with their result, land 40.9 percent still show ed a positive Trendelenburg gait at follow-up. The perioperative mortality was 2.7 percent. Surgery-related femoral fractures or fissures were observe d in 18 cases, and deep infections in four. Conclusions: In comparison with data of patients who had undergone primary total hip arthroplasty for oste oarthritis in our department, the results reported here after secondary hip replacement are clearly inferior. Nonetheless, alloarthroplasty of the hip still is the most effective procedure after failed internal fixation for a cetabular or proximal femoral fractures.