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Primary Complex Total Hip Arthroplasty in Neglected Anterior Hip Dislocation With Comminuted Pertrochanteric Femur Fracture.

ABSTRACT: Neglected anterior hip dislocation combined with comminuted pertrochanteric ipsilateral fracture of the femur is rare, with few reports in the literature. The present report describes the case of a 7-month-old neglected anterior hip dislocation with a pertrochanteric femoral fracture in a 45-year-old male patient. The patient was treated with total hip arthroplasty with proximal femoral reconstruction. The 2-year follow-up showed good clinical and radiological outcomes with a painless and mobile hip joint. The Harris-Hip score improved from 10 (preoperatively) to 89 (postoperatively) after 2 years. The patient was satisfied with the intervention and showed minimal lurch with ambulation with no leg-length discrepancy. However, long-term results from periodic follow-up are warranted.

SUBMITTER: Singh A

PROVIDER: S-EPMC8430435 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Primary Complex Total Hip Arthroplasty in Neglected Anterior Hip Dislocation With Comminuted Pertrochanteric Femur Fracture.

Singh Ashish A Kumar Purushotam P Singh Sushil S Singh Rabindra Narain RN Telagareddy Kartheek K

Arthroplasty today 20210710

Neglected anterior hip dislocation combined with comminuted pertrochanteric ipsilateral fracture of the femur is rare, with few reports in the literature. The present report describes the case of a 7-month-old neglected anterior hip dislocation with a pertrochanteric femoral fracture in a 45-year-old male patient. The patient was treated with total hip arthroplasty with proximal femoral reconstruction. The 2-year follow-up showed good clinical and radiological outcomes with a painless and mobile ...[more]

PMID: 34527797

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Project description:BackgroundMany risk factors have been described for dislocation following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions.MethodsIn this study, 29,349 THAs, including 21,978 primary and 7371 revision cases, performed between 1998 and 2018 were evaluated. During a mean 6-year follow-up, 1521 THAs were followed by a dislocation. Patients were characterized, through individual-chart review, according to non-modifiable factors (demographics, indication for THA, spine disease, prior spine surgery, and neurologic disease) and modifiable operative decisions (operative approach, femoral head diameter, and type of acetabular liner [standard, elevated, constrained, or dual-mobility]). Multivariable regression models and nomograms were developed with dislocation as a binary outcome at 1 year and 5 years postoperatively.ResultsDislocation risk, based on patient-specific comorbidities and operative decisions, was wide-ranging-from 0.3% to 13% at 1 year and from 0.4% to 19% at 5 years after primary THA, and from 2% to 32% at 1 year and from 3% to 42% at 5 years after revision THA. In the primary-THA group, the direct anterior approach (hazard ratio [HR] = 0.27) and lateral approach (HR = 0.58) decreased the dislocation risk compared with the posterior approach. After adjusting for the approach in that group, the combination of a ≥36-mm-diameter femoral head and an elevated liner yielded the largest decrease in dislocation risk (HR = 0.28), followed by dual-mobility constructs (HR = 0.48). In the patients who underwent revision THA, the adjusted risk of dislocation was most markedly decreased by the use of a dual-mobility construct (HR = 0.40), followed by a ≥36-mm femoral head and an elevated liner (HR = 0.88). The adjusted risk of dislocation after revision THA was decreased by acetabular revision (HR = 0.58), irrespective of whether other components were revised.ConclusionsOur patient-specific dislocation risk calculator, which was strengthened by our use of a robust multivariable model that accounted for comorbidities associated with instability, demonstrated wide-ranging patient-specific risks based on comorbidity profiles. The resultant nomograms can be used as a screening tool to identify patients at high risk for dislocation following THA and to individualize operative decisions for evidence-based risk mitigation.Level of evidencePrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Dataset Information

Primary Complex Total Hip Arthroplasty in Neglected Anterior Hip Dislocation With Comminuted Pertrochanteric Femur Fracture.

Publications

Primary Complex Total Hip Arthroplasty in Neglected Anterior Hip Dislocation With Comminuted Pertrochanteric Femur Fracture.

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