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Outcomes of Total Hip Replacement for Failed Hemiarthroplasty

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Abstract

Aim

Our study aims to analyze the outcomes of conversion total hip replacement (THR) done for failed hemiarthroplasty.

Patients and Methods

We retrospectively analyzed 104 consecutive patients who underwent conversion THR for failed hemiarthroplasty between January 2012 and December 2018. The patient’s records were analyzed for demographic information, index surgery details, preoperative functional status, and perioperative complications. Patients were analyzed according to the various modes of failure of hemiarthroplasty. The radiographs were analyzed for any progressive osteolysis, cup migration and stem subsidence. All the patients were evaluated using the modified Harris hip score (HHS) for clinical outcome. Complications, revision or reoperation in the follow-up period was recorded.

Results

A total of 73 patients were included in the study for final analysis after exclusion criteria. The average follow-up was 48.2 ± 29.6 months. There was a significant improvement in mean HHS from 38.5 ± 9.1 preoperatively to 80.9 ± 4.3 at the last follow-up (p < 0.05). The different modes of failure had no statistically significant difference in the postoperative Harris hip score (p = 0.393). None of the patients had progressive radiolucent lines more than 2 mm or significant subsidence in the final follow-up compared to the initial postoperative radiograph. There was one deep infection, one patient had grade 2 heterotopic ossification, intraoperative calcar fracture was fixed with cerclage wiring in 11 patients, and postoperative periprosthetic fracture in two patients was treated with plate osteosynthesis. There were no neurovascular complications or dislocation during the follow-up.

Conclusion

Conversion THR for failed hemiarthroplasty is a challenging procedure and results in good functional outcome and provides reliable pain relief. Conversion THA for septic loosening by two stage revision have comparable postoperative outcomes like THA for aseptic loosening. Caution is required owing to high incidence of peri-prosthetic fracture during conversion THA. Dislocation rate is negligible even with smaller head provided the prosthesis is implanted in the proper orientation and adequate soft tissue balancing is achieved.

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References

  1. Sheth, N. P., Dattilo, J. R., & Schwarzkopf, R. (2018). Evaluation and management of failed hemiarthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 26(20), 717–726. https://doi.org/10.5435/JAAOS-D-16-00723

    Article  PubMed  Google Scholar 

  2. Suryawanshi, A., Bhosale, P., & Mittal, A. (2012). Total hip arthroplasty for failed aseptic Austin Moore prosthesis. Indian J Orthop., 46(3), 297. https://doi.org/10.4103/0019-5413.96387

    Article  PubMed  PubMed Central  Google Scholar 

  3. Huang, T. W., Chang, C. H., Chang, F. C., et al. (2019). Results of conversion from failed Austin-Moore hemiarthroplasty to cementless total hip arthroplasty in octogenarian patients with advanced acetabular erosion: a minimum of 5 years of follow-up. BioMed Research International., 2019, 1–6. https://doi.org/10.1155/2019/7814602

    Article  CAS  Google Scholar 

  4. Sierra, R. J., & Cabanela, M. E. (2002). Conversion of failed hip hemiarthroplasties after femoral neck fractures. Clinical Orthopaedics and Related Research., 399, 129–139. https://doi.org/10.1097/00003086-200206000-00015

    Article  Google Scholar 

  5. Grosso, M. J., Danoff, J. R., Thacher, R., et al. (2018). Risk factors for conversion surgery to total hip arthroplasty of a hemiarthroplasty performed for a femoral neck fracture. HIP International., 28(2), 168–172. https://doi.org/10.1177/1120700018768654

    Article  PubMed  Google Scholar 

  6. Schmitz, P. P., van Susante, J. L. C., & Somford, M. P. (2019). Low conversion rates toward total hip arthroplasty after hemiarthroplasty in patients under 75 years of age. European Journal of Orthopaedic Surgery & Traumatology, 29(8), 1687–1691. https://doi.org/10.1007/s00590-019-02498-0

    Article  CAS  Google Scholar 

  7. Hernandez, N. M., Fruth, K. M., Larson, D. R., Kremers, H. M., & Sierra, R. J. (2019). Conversion of failed hemiarthroplasty to total hip arthroplasty remains high risk for subsequent complications. The Journal of Arthroplasty., 34(9), 2030–2036. https://doi.org/10.1016/j.arth.2019.04.042

    Article  PubMed  Google Scholar 

  8. Park, K. S., Chan, C. K., Lee, D. H., & Yoon, T. R. (2018). Midterm results of conversion from failed bipolar hemiarthroplasty to total hip arthroplasty. Indian Journal of Orthopaedics., 52(4), 369. https://doi.org/10.4103/ortho.IJOrtho_494_16

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bhan, S., Pankaj, A., & Malhotra, R. (2008). Conversion of failed hemiarthroplasty to total hip arthroplasty: A short to mid-term follow-up study. Indian J Orthop., 42(3), 294. https://doi.org/10.4103/0019-5413.41852

    Article  PubMed  PubMed Central  Google Scholar 

  10. Morsi, E., Habib, M. E., Elseedy, A., & Eid, T. (2016). Revision of failed hip hemiarthroplasty. Classification, management, and follow-up. Journal of orthopaedics., 13(2), 63–68.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Baker, R. P., Squires, B., Gargan, M. F., Bannister, G. C. (2006). Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: A randomized, controlled trial. The Journal of Bone & Joint Surgery, 88(12), 2583–2589. https://doi.org/10.2106/JBJS.E.01373

  12. Sharma, S., Shah, R., Draviraj, K. P., & Bhamra, M. S. (2005). Use of telephone interviews to follow up patients after total hip replacement. Journal of Telemedicine and Telecare, 11(4), 211–214. https://doi.org/10.1258/1357633054068883

    Article  PubMed  Google Scholar 

  13. Nunn, D., Freeman, M. A., Hill, P. F., & Evans, S. J. (1989). The measurement of migration of the acetabular component of hip prostheses. Journal of Bone and Joint Surgery. British Volume., 71(4), 629–631.

    Article  CAS  PubMed  Google Scholar 

  14. Ries, C., Boese, C. K., Dietrich, F., et al. (2019). Femoral stem subsidence in cementless total hip arthroplasty: A retrospective single-centre study. International Orthopaedics (SICOT), 43, 307–314. https://doi.org/10.1007/s00264-018-4020-x

    Article  Google Scholar 

  15. Hug, K. T., Alton, T. B., & Gee, A. O. (2015). In brief: classifications in brief: brooker classification of heterotopic ossification after total hip arthroplasty. Clinical Orthopaedics and Related Research, 473(6), 2154–2157. https://doi.org/10.1007/s11999-014-4076-x

    Article  PubMed  Google Scholar 

  16. Weinrauch, P. (2006). Intra-operative error during austin moore hemiarthroplasty. Journal of Orthopaedic Surgery (Hong Kong), 14(3), 249–252. https://doi.org/10.1177/230949900601400304

    Article  CAS  PubMed  Google Scholar 

  17. Inngul, C., Hedbeck, C. J., Blomfeldt, R., Lapidus, G., Ponzer, S., & Enocson, A. (2013). Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial. International Orthopaedics (SICOT)., 37(12), 2457–2464. https://doi.org/10.1007/s00264-013-2117-9

    Article  Google Scholar 

  18. Taylor, D. M., Ashford, R. U., & Collier, A. M. (2004). Fatigue fracture of an Austin Moore uncemented hemi-arthroplasty: a case report. European Journal of Orthopaedic Surgery & Traumatology. https://doi.org/10.1007/s00590-004-0157-y

    Article  Google Scholar 

  19. Bhatia, M., & Edge, J. (2004). Fracture of hydroxyapatite coated prostheses: A report of two cases of stem failure in hip hemiarthroplasty. European Journal of Orthopaedic Surgery & Traumatology., 14(1), 42–44. https://doi.org/10.1007/s00590-003-0111-4

    Article  Google Scholar 

  20. Bayam, L., Drampalos, E., Nagai, H., & Kay, P. (2019). Conversion of failed hip hemiarthroplasty to low friction arthroplasty (LFA). JCM., 8(4), 503. https://doi.org/10.3390/jcm8040503

    Article  PubMed  PubMed Central  Google Scholar 

  21. Blewitt, N., & Mortimore, S. (1992). Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury, 23(5), 320–322. https://doi.org/10.1016/0020-1383(92)90179-V

    Article  CAS  PubMed  Google Scholar 

  22. Chalmers, B. P., Perry, K. I., Hanssen, A. D., Pagnano, M. W., & Abdel, M. P. (2017). Conversion of hip hemiarthroplasty to total hip arthroplasty utilizing a dual-mobility construct compared with large femoral heads. The Journal of Arthroplasty., 32(10), 3071–3075. https://doi.org/10.1016/j.arth.2017.04.061

    Article  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India

    Natesan Rajkumar, Dhanasekaran Soundarrajan, Gowtham Ram, Palanisami Dhanasekararaja & Shanmuganathan Rajasekaran

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  1. Natesan Rajkumar
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Correspondence to Natesan Rajkumar.

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Conflict of interest

Natesan Rajkumar, Dhanasekaran Soundarrajan, Gowtham Ram, Palanisami Dhanasekararaja and Shanmuganathan Rajasekaran declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent in Studies with Human Subjects

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

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Rajkumar, N., Soundarrajan, D., Ram, G. et al. Outcomes of Total Hip Replacement for Failed Hemiarthroplasty. JOIO 57, 679–688 (2023). https://doi.org/10.1007/s43465-023-00849-y

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  • DOI: https://doi.org/10.1007/s43465-023-00849-y

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