title: Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures.
abstract: OBJECTIVE
  Hip arthroplasty is an option for elderly patients with osteoporosis for the treatment of failure after fixation of trochanteric and subtrochanteric fractures, either as a total hip arthroplasty (THA) or as a hemiarthroplasty (HA). We analyzed the reoperation rate and risk factors for reoperation in a consecutive series of patients.
  
  
  METHODS
  All patients (n = 88) operated from 1999 to 2006 with a THA (n = 63) or an HA (n = 25) due to failure of fixation of a trochanteric fracture (n = 63) or subtrochanteric fracture (n = 25) were included. Background data were collected from the patient records. A search was performed in the national registry of the Swedish National Board of Health and Welfare in order to find information on all reoperations. The follow-up time was 5-11 years.
  
  
  RESULTS
  The reoperation rate was 16% (14/88 hips). A periprosthetic fracture occurred in 6 patients, a deep prosthetic infection in 5 patients, and a dislocation of the prosthesis in 3 patients. Standard-length femoral stems had an increased risk of reoperation (11/47) compared to long stems (3/41) (HR = 4, 95% CI: 1.0-13; p = 0.06).
  
  
  CONCLUSIONS
  The high reoperation rate reflects the complexity of the surgery. Using long femoral stems that bridge previous holes and defects may be one way to reduce the risk for reoperation.
authors.affiliation: Orthopaedic Unit, Department of Clinical Science and Education, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden. anders.enocson@sodersjukhuset.se
authors.forename: Anders
authors.initials: A
authors.lastname: Enocson
authors.forename: Leif
authors.initials: L
authors.lastname: Mattisson
authors.forename: Carin
authors.initials: C
authors.lastname: Ottosson
authors.forename: Lasse J
authors.initials: LJ
authors.lastname: Lapidus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D057068:Periprosthetic Fractures / Q000209:etiology; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D017211:Treatment Failure