Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients

Purpose: Total hip arthroplasty (THA) after failed osteosynthesis for proximal femoral fractures is associated with higher revision rates, particularly for dislocation. The purpose of this study was to report our results with THA after failed osteosynthesis within a treatment period of 10 years. Methods: A retrospective cohort study including 80 consecutive patients was conducted. After a minimum follow-up of 1 year, we evaluated revision for any cause including dislocation, outcome, and mortality. Results: We performed 48 THAs with standard components only and 32 THAs with revision implants. Routinely, a 36-mm femoral head was used, and trochanteric fixation was performed in one-third of the cases. Total revision rate for any cause was 21%, which included six infections, six periprosthetic fractures, and five hematomas. One hip dislocation was also treated. Treatment with uncemented revision stem revealed significantly higher number of revisionscompared to standard cemented or uncemented stem. The mortality rate after 1 year was 9%, and the mean Parker score at follow-up was 6.6 (range: 0-9). Conclusions: THA was associated with an increased surgical revision rate, but hip dislocation was documented only once. In most cases, a standard implant with a large 36-mm femoral head size was sufficient. Uncemented revision stem revealed significantly higher number of revisionscompared to standard cemented or uncemented stem. One-year mortality was lower than expected.