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Total hip arthroplasty for failed aseptic Austin Moore prosthesis.

Bhosale P, Suryawanshi A, Mittal A - Indian J Orthop (2012)

Bottom Line: Average Harris Hip Score improved from 65 preoperatively (range 42-73) to 87 (range 76-90) at 1 year postoperatively and to 86 (range 75-89) at the last followup.The overall complication rate was 4.5%.Conversion THA is an excellent treatment strategy for symptomatic failed AM hemiarthroplasty in terms of pain relief and restoration of function and mobility as near as possible to the preinjury level.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India.

ABSTRACT

Background: Though Austin Moore (AM) replacement prosthesis has fairly good short term results for intracapsular femoral neck fractures in the elderly, it still is a compromised option and has a high failure rate in the long run. The objective of the present retrospective study is to analyze the functional outcome, assess survivorship of revision total hip arthroplasty (THA) at mid to long term followup, and evaluate intraoperative difficulties faced during conversion of failed aseptic AM prosthesis to cemented THA.

Materials and methods: Eighty-nine cemented THA surgeries for failed AM prosthesis were performed between 1986 and 2005. AM failures were classified into seven groups on the basis of mode of failure. Infected failures were excluded from the study. There were 35 men and 54 women in the study group. The mean age was 68 years (range 57-91 years). Mean followup was 8 years (range 5-13 years).

Results: Average Harris Hip Score improved from 65 preoperatively (range 42-73) to 87 (range 76-90) at 1 year postoperatively and to 86 (range 75-89) at the last followup. The overall complication rate was 4.5%.

Conclusion: Conversion THA is an excellent treatment strategy for symptomatic failed AM hemiarthroplasty in terms of pain relief and restoration of function and mobility as near as possible to the preinjury level. Also, hemiarthroplasty should not be used in physically active patients, even in elderly individuals. Careful patient selection for hemiarthroplasty versus THA is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.

No MeSH data available.


Related in: MedlinePlus

(a) Lateral radiographs of the prosthesis showing false tract posteriorly in the shaft of femur. (b) Bypassing the false tract with cannulated reamers over guide wire
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Figure 1: (a) Lateral radiographs of the prosthesis showing false tract posteriorly in the shaft of femur. (b) Bypassing the false tract with cannulated reamers over guide wire

Mentions: During exposure, when external rotators and capsule were difficult to identify (because of prior surgery), the scar tissue was elevated “en masse” from the intertrochanteric ridge posteriorly to prevent sciatic nerve injury. Before dislocating, femur was lateralized with bone hook and scar tissue was released meticulously from all around the prosthesis. Then, the prosthesis was dislocated posteriorly by flexing, adducting, and internally rotating the hip, checking synchronous motion of femur with prosthesis to avoid periprosthetic fractures. The anterior capsule, any scar tissue, and osteophytes were removed at this stage. Before extraction, the piriform fossa and the proximal periprosthetic area were cleared of any bone and fibrous tissue using bone nibblers and thin osteotomes so as to visualize prosthesis extraction holes. Then, the prosthesis was extracted using devices like bone hook, universal extractor, etc. In a few cases, cortical erosion and false tract [Figure 1] were found for which we first used an interlock nailing guide wire to negotiate false tract and then femoral reaming was done over guide wire using cannulated flexible reamers. Fiberoptic headlight was used to visualize the fibrous membrane and slightly angled curettes and metal bristle roller brush were used to remove it. Femoral and acetabular preparation and cementing were done using standard techniques. The results were evaluated using Harris Hip Score recorded preoperatively, at 1 year, and at each followup visit. Mean followup duration was 8 years (range 5-13 years). For statistical analysis, paired t-test was used to evaluate possible statistical differences of preoperatively and postoperatively values. Statistical significance was set at P<0.05.


Total hip arthroplasty for failed aseptic Austin Moore prosthesis.

Bhosale P, Suryawanshi A, Mittal A - Indian J Orthop (2012)

(a) Lateral radiographs of the prosthesis showing false tract posteriorly in the shaft of femur. (b) Bypassing the false tract with cannulated reamers over guide wire
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377140&req=5

Figure 1: (a) Lateral radiographs of the prosthesis showing false tract posteriorly in the shaft of femur. (b) Bypassing the false tract with cannulated reamers over guide wire
Mentions: During exposure, when external rotators and capsule were difficult to identify (because of prior surgery), the scar tissue was elevated “en masse” from the intertrochanteric ridge posteriorly to prevent sciatic nerve injury. Before dislocating, femur was lateralized with bone hook and scar tissue was released meticulously from all around the prosthesis. Then, the prosthesis was dislocated posteriorly by flexing, adducting, and internally rotating the hip, checking synchronous motion of femur with prosthesis to avoid periprosthetic fractures. The anterior capsule, any scar tissue, and osteophytes were removed at this stage. Before extraction, the piriform fossa and the proximal periprosthetic area were cleared of any bone and fibrous tissue using bone nibblers and thin osteotomes so as to visualize prosthesis extraction holes. Then, the prosthesis was extracted using devices like bone hook, universal extractor, etc. In a few cases, cortical erosion and false tract [Figure 1] were found for which we first used an interlock nailing guide wire to negotiate false tract and then femoral reaming was done over guide wire using cannulated flexible reamers. Fiberoptic headlight was used to visualize the fibrous membrane and slightly angled curettes and metal bristle roller brush were used to remove it. Femoral and acetabular preparation and cementing were done using standard techniques. The results were evaluated using Harris Hip Score recorded preoperatively, at 1 year, and at each followup visit. Mean followup duration was 8 years (range 5-13 years). For statistical analysis, paired t-test was used to evaluate possible statistical differences of preoperatively and postoperatively values. Statistical significance was set at P<0.05.

Bottom Line: Average Harris Hip Score improved from 65 preoperatively (range 42-73) to 87 (range 76-90) at 1 year postoperatively and to 86 (range 75-89) at the last followup.The overall complication rate was 4.5%.Conversion THA is an excellent treatment strategy for symptomatic failed AM hemiarthroplasty in terms of pain relief and restoration of function and mobility as near as possible to the preinjury level.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India.

ABSTRACT

Background: Though Austin Moore (AM) replacement prosthesis has fairly good short term results for intracapsular femoral neck fractures in the elderly, it still is a compromised option and has a high failure rate in the long run. The objective of the present retrospective study is to analyze the functional outcome, assess survivorship of revision total hip arthroplasty (THA) at mid to long term followup, and evaluate intraoperative difficulties faced during conversion of failed aseptic AM prosthesis to cemented THA.

Materials and methods: Eighty-nine cemented THA surgeries for failed AM prosthesis were performed between 1986 and 2005. AM failures were classified into seven groups on the basis of mode of failure. Infected failures were excluded from the study. There were 35 men and 54 women in the study group. The mean age was 68 years (range 57-91 years). Mean followup was 8 years (range 5-13 years).

Results: Average Harris Hip Score improved from 65 preoperatively (range 42-73) to 87 (range 76-90) at 1 year postoperatively and to 86 (range 75-89) at the last followup. The overall complication rate was 4.5%.

Conclusion: Conversion THA is an excellent treatment strategy for symptomatic failed AM hemiarthroplasty in terms of pain relief and restoration of function and mobility as near as possible to the preinjury level. Also, hemiarthroplasty should not be used in physically active patients, even in elderly individuals. Careful patient selection for hemiarthroplasty versus THA is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.

No MeSH data available.


Related in: MedlinePlus