Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery?  

作　　者：Giuseppe Solarino Davide Bizzoca Pasquale Dramisino Giovanni Vicenti Lorenzo Moretti Biagio Moretti Andrea Piazzolla 

机构地区：[1]University of Bari Aldo Moro,Bari 70154,Italy [2]Orthopaedic and Trauma Unit Policlinico di Bari,Bari 70124,Italy [3]UOSD Vertebral Surgery,Policlinico di Bari,Bari 70124,Italy

出　　处：《World Journal of Orthopedics》2023年第10期763-770,共8页世界骨科杂志（英文版）

摘　　要：BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was obser

关 键 词：Femoral nailing Total hip arthroplasty Proximal femur fractures OSTEOPOROSIS Fragility fractures Geriatric patients Hip traumatology Hip replacement 

分 类 号：R687.4[医药卫生—骨科学]