The anterior approach for conversion hip arthroplasty
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The treatment of proximal femur fractures utilizing screws, sliding hip screw (SHS) device, or a cephalomedullary nail (CMN) is a common procedure. This fixation can fail via various modes. Conversion to hemiarthroplasty or total hip arthroplasty (THA) is generally successful at decreasing pain and improving function. The anterior approach (AA) has gained in popularity for primary THA.

Here present a case of an 81-year-old male, 5′8″, and 104 kg, with primarily central/abdominal obesity and body mass index (BMI) of 35. Medical history is significant for diabetes mellitus DM, prostate cancer, gout, former tobacco use, and chronic kidney disease 3 . He underwent SHS fixation of an intertrochanteric femur fracture elsewhere

In the initial presentation 15 months after open reduction internal fixation, he had severe hip pain, with 2-3 block walking tolerance. CT scan, infectious labs, and aspiration were performed. The CT scan revealed a nonunion , with labs and aspiration negative for infection, supporting aseptic nonunion as the etiology for the patient’s pain. With progressive discomfort and decreased ambulatory capacity, conversion occurred 20 months after original open reduction internal fixation.

A collared, metaphyseal/diaphyseal engaging, uncemented stem was utilized. Preoperative hematocrit (HCT) was 34.8. Postoperative day (POD) POD # 4. He was allowed 50% weight bearing initially and made slow progress with a rolling walker. Weight bearing of 50% was planned for 6 weeks, primarily to decrease the risk of possible trochanteric fracture given the large overlying trochanteric bone, the stress seen in a large male with BMI 35, and the bone compromise from the lateral hole at the SHS site. He transferred to an skilled nursing facility at discharge. On clinic follow-up he progressed in ambulatory capacity, utilizing a cane while in crowds but no assistive device otherwise at follow-up 12 months postoperative

Summary conversion of proximal femoral fracture fixation to hip arthroplasty can be performed utilizing the AA. Studies to date have utilized alternative approaches. Additional studies are required to determine the role of the approach in conversion THA.

Source: https://www.sciencedirect.com/science/article/pii/S2352344119300445
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