TROCHANTERIC NON-UNION TREATED WITH HOOK-PLATE AND CABLE SYSTEM ALONG WITH TOTAL HIP REPLACEMENT

Abstract

Introduction: Trochanteric fracture fixations sometime fail due to various reasons like implant failure or osteoporosis. Treatment in such a situations is difficult as the surgeon faces multiple challenges like bad bone stock, cartilage damage in the femoral head due to screw cut out, weak musculature and need for early mobilization considering the age and comorbidities of such patients. The purpose of the study is to evaluate the outcome of Trochanteric fixation along with a distal loading stem for hip replacement. Materials and methods: We conducted a prospective study to follow-up 12 patients who have undergone trochanteric fixation with locking plates with cables and screws for trochanteric fixation failures with osteochondral damage in the hip joint from the previous fixation device. Results: The patients were assessed with Harris hip scores which improved from 42 preop to 94 postop (p <0.001). No patient had significant pain or abductor lurch postoperatively (p <0.001).  Active abduction increased from 0 deg preop to 28 degree postoperatively (p <0.001). Though bony union was not complete in 3 out of 12 patients fibrous union allowed the patients to be ambulant without symptoms. Conclusion: Trochanteric hook plate gives sufficient fixation strength for trochanteric fixations along with a distal loading stem in total hip replacement in patients where trochanteric fixation failure has occurred and the fixation device has caused and osteochondral damage to the acetabulum.