Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2023; 14(10): 763-770
Published online Oct 18, 2023. doi: 10.5312/wjo.v14.i10.763
Total hip arthroplasty following the failure of intertrochanteric nailing: First implant or salvage surgery?
Giuseppe Solarino, Davide Bizzoca, Pasquale Dramisino, Giovanni Vicenti, Lorenzo Moretti, Biagio Moretti, Andrea Piazzolla
Giuseppe Solarino, Pasquale Dramisino, Giovanni Vicenti, Biagio Moretti, DiBraiN, University of Bari Aldo Moro, Bari 70154, Italy
Davide Bizzoca, DiMePre-J, University of Bari Aldo Moro, Bari 70154, Italy
Lorenzo Moretti, Orthopaedic and Trauma Unit Policlinico di Bari, Bari 70124, Italy
Andrea Piazzolla, UOSD Vertebral Surgery, Policlinico di Bari, Bari 70124, Italy
Author contributions: Bizzoca D and Solarino G contributed to the investigation, data analysis, and writing; Dramisino P, Vicenti G, and Moretti L contributed to writing the first draft; Moretti B and Piazzolla A contributed to supervision and funding acquisition.
Institutional review board statement: Ethical clearance was obtained from our center’s clinical research ethics board as per the 1964 Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare having no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Davide Bizzoca, MD, PhD, Surgeon, DiMePre-J, University of Bari Aldo Moro, 11 Piazza Giulio Cesare, Bari 70154, Italy. davide.bizzoca@uniba.it
Received: May 31, 2023
Peer-review started: May 31, 2023
First decision: July 19, 2023
Revised: August 16, 2023
Accepted: September 6, 2023
Article in press: September 6, 2023
Published online: October 18, 2023
Abstract
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 follow-up. 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 observed, whereas in 1 case (1.4%) a late THA dislocation was observed. Three patients out of 71 (4.2%) developed a periprosthetic joint infection during the study follow-up.

CONCLUSION

The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.

Keywords: Femoral nailing, Total hip arthroplasty, Proximal femur fractures, Osteoporosis, Fragility fractures, Geriatric patients, Hip traumatology, Hip replacement

Core Tip: The present study demonstrated that salvage options for intertrochanteric femoral fracture fixation failure deal with intraoperative and postoperative complications at a higher rate compared to primary elective total hip arthroplasty.