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Total Hip Replacement after an Unhealed Hip Fracture

Doctors at the Mayo Clinic report the long-term results of a total hip replacement (THR) after a hip fracture didn't heal. They followed 99 patients with this problem between two and 15 years after surgery. All patients received the same kind of total hip implant (a cemented Charnley).

Almost all of the hip fractures had been treated first with a metal plate and screws to hold the break together. The bone didn't heal, and the hips were converted to a THR. Patients were followed on a regular basis at two months, one year, two years, and five years after the operation. Everyone was still seen or contacted at five-year intervals after that.

Results were measured using X-rays, pain levels, and ability to walk without help. Twelve hips needed a second operation. Most were redone because the implant came loose or dislocated. In a few cases, there was a hip infection.

The authors report that the hip implant lasted longer in older men who were not overweight. The implant was less durable in younger patients. In general, the implant didn't last as long in patients with hip fractures compared to patients without a hip fracture. This may be because fractures repaired first with plates and screws have holes in them. This makes the bone weaker, so the implant doesn't hold up as well. The high dislocation rate suggests that doctors must choose the implant type and method of surgery carefully in patients with a previous hip fracture that doesn't heal.

References: Tad M. Mabry, MD, et al. Long-Term Results of Total Hip Arthroplasty for Femoral Neck Fracture Nonunion. In The Journal of Bone and Joint Surgery. October 2004. Vol. 86-A. No. 10. Pp. 2263-2267.

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