Artroplastia de cadera luego de una osteosíntesis fallida en fracturas laterales de cadera. [Hip arthroplasty for failed internal fixation of intertrochanteric fractures.]

Fernando Lopreite, German Garabano, Cesar Pesciallo, Hernan Del Sel

Resumen


 

Introducción

El objetivo de este estudio retrospectivo fue evaluar el comportamiento clínico-radiológico, las complicaciones y las dificultades técnicas de los reemplazos de cadera luego de una osteosíntesis fallida con tornillo placa dinámico (DHS) en fracturas laterales de cadera.

Materiales y Métodos

Se analizaron 38 reemplazos de cadera en 38 pacientes (31 mujeres y 7 hombres, edad promedio 75.59 años [rango 67-90]), con un seguimiento de 45.5 meses (rango 16-128). Se realizaron 30 reemplazos totales, 7 con prótesis bipolares y uno con una endoprótesis no convencional. En 29 casos, la longitud del tallo femoral fue estándar y 9 eran largos. Clínicamente se evaluó la presencia de dolor y objetivamente se utilizó el puntaje de cadera de Harris. En las radiografías, se analizaron la calidad del cementado (Barrack), las demarcaciones protésicas, la presencia de aflojamiento, seudoartrosis del trocánter mayor y sus complicaciones.

Resultados

El puntaje de Harris promedio posoperatorio fue de 79 (rango 70-88). De los 35 tallos cementados, 30 fueron clase A; cuatro, B y uno, C de Barrack. No hubo revisiones. Cuatro cotilos cementados presentaron demarcación en zona I; uno, en zona II y III; y otro, en las tres zonas. Hubo 5 seudoartrosis del trocánter mayor, 3 infecciones agudas que evolucionaron favorablemente con limpieza quirúrgica y antibióticos. Tres pacientes sufrieron luxaciones, uno requirió revisión.

Conclusiones

El rescate de un DHS fallido mediante un reemplazo de cadera representa un procedimiento con resultados funcionales aceptables, devuelve a los pacientes la capacidad de marcha. Es un procedimiento técnicamente demandante y se asocia a una alta tasa de complicaciones.

 

Abstract


Introduction: The purpose of this retrospective study was to assess the clinical and radiological outcomes, complications, and technical problems of total hip arthroplasty following failure of dynamic screw fixation of the intertrochanteric fractures.


Methods: Thirty-eight total hip arthroplasties in 38 patients were reviewed (31 women and 7 men, with a mean age of 75.59 years [range 67-90]), with a follow-up of 45.5 months (range 16-128). Thirty were total hip arthroplasties, 7 bipolar hip arthroplasties and an unconventional prosthesis. Nine large femoral stems and 29 standard stems were used. The presence of pain was clinically evaluated, and the Harris hip score was objectively used. Quality of cementation (Barrack), prosthetic demarcations, loosening, pseudoarthrosis of the greater trochanter and its complications were analyzed in X-rays.

Results: Average Harris Hip Score was 79 points (range 70-88). Thirty of 35 cemented femoral stems were type A (Barrack), 4 type B and one type C. There were no revisions. Four cemented cotyles had a demarcation line in zone I, one, in zones II and III; and the other in the three zones. There were 5 nonunion of greater trochanter, 3 acute infections with favorable outcome after toilette and antibiotics. Three patients suffered dislocations, one of them needed revision.

 
Conclusions: Total hip arthroplasty as salvage procedure after failed dynamic screw fixation achieves acceptable functional results and allows ambulation. This procedure is technically challenging with a high complication rate.


Palabras clave


fractura intertrocantérica; DHS; osteosíntesis fallida; Reemplazo de Cadera.Intertrochanteric fracture; DHS; failed internal fixation; total hip arthroplasty.

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DOI: http://dx.doi.org/10.15417/725

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