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Comment on Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. (Visit this link)
Commentary & Perspective on "Hip Arthroplasty for Salvage of Failed Treatment of Intertrochanteric Hip Fractures" by George J. Haidukewych, MD, and Daniel J. Berry, MD by John J. Callaghan, MD*, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA In summary, this article is helpful to the surgeon performing hip arthroplasty in patients with previous intertrochanteric femoral fractures and to the patients and families of the patients considering this operation. For the patient disabled by the failure of internal fixation of an intertrochanteric femoral fracture, hip arthroplasty can provide durable fixation and pain relief (although the surgeon should explain to the patients that they may have some residual pain in the greater trochanter). Addressing the patients’ preoperative and postoperative medical problems are paramount, as long operative times and large amounts of blood loss are not uncommon with this procedure. Trochanteric osteotomy may be required to provide adequate exposure, and hardware should probably be removed after dislocating the hip to prevent fractures of the femoral shaft. The surgeon should compensate for proximal bone loss with a calcar-replacement implant and bypass any screw-holes in the femoral shaft with use of a long-stem prosthesis. If acetabular cartilage is preserved, a bipolar replacement may aid hip stability. If a total hip arthroplasty is chosen, and hip stability is problematic, a constrained implant can be used (because of low patient demands), especially if the abductor musculature is compromised. Postoperative prophylaxis against thromboembolism should be utilized. If these principles, outlined by Haidukewych and Berry, are followed, satisfying results of salvage hip arthroplasty in patients who have had failed treatment of an intertrochanteric fracture can be obtained.
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Added: Sun Dec 17 2006
Last Modified: Mon Jul 02 2007
