Complications in hip fractures treated with total arthroplasty

Abstract

Total hip arthroplasty is the most frequently performed hip joint reconstructive procedure in adults. There are different approaches: the anterior, the anterolateral, and the posterior (posterolateral) approaches. Different femoral head diameters are used, being 28, 32 and 36 mm the most used. Complications are highly variable and range from dislocation, aseptic loosening, infection, neurological and vascular injury, nonunion of the trochanter, periprosthetic fractures, and even heterotopic ossification. Objective: to describe the early complications during the first postoperative year of patients with primary total hip arthroplasty.

A retrospective, descriptive study of 54 primary hip arthroplasties with hip fractures, through the posterolateral approach, was carried out from June 2019 to the end of May 2020, with a one-year follow-up performed in a private institution.
The average age was 78 years; retired, 41 (76%) women and 13 (24%), men. Average of 5 days until the moment of surgery.
37 cemented prostheses, 11 non-cemented prostheses and 6 hybrid prostheses were used. In all these prostheses, a femoral head with a diameter of 28 mm was placed. All underwent surgery with a posterolateral approach. The first post-surgical control was carried out at 15 days, radiographic control at a month, new controls at 6 weeks, 3 months, 6 months and annually. Complications that occurred during the intraoperative period and up to one year after the surgical intervention were analyzed.

The total number of complications occurred in 18 patients, that is, 33%. 8 required post-surgical blood transfusion (16.6%), 7 prosthetic dislocation (12.9%), 9 died within the first 3 postoperative months (5.5%), 3 presented periprosthetic infection (5.5%), and one suffered from deep vein thrombosis ( 1.1%). Five patients presented two or more complications, two required blood transfusion and presented prosthetic dislocation. One suffered periprosthetic infection and later died. Two patients who also required postoperative blood transfusion died within a year.

Hip dislocation is the most frequent complication. The use of femoral heads of 32 mm or greater diameter will favor the prevention of episodes of prosthetic dislocation, in addition, we highlight capsular repair with reinsertion of the rotator muscles.