Pertrokanterik Kırıklarda Proksimal Femoral Çivilemede (PFÇ) “Cut-out” Komplikasyonu Sonrası Kalça Artroplastisine Geçiş

Abstract

Objectives: A failed intertrochanteric fixation often leads to functional disability and pain. The most commonly observed complication is “cut-out”,which frequently requires hip arthroplasty in the subsequent period. In this study, we aimed to compare the results of total hip arthroplasty (THA) and hemiarthroplasty (HA) after cut-out complication of proximal femoral nailing (PFN). Materials and Methods: Forty patients who were treated with THA (20 patients) and HA (20 patients) due to cut-out complication following PFN were included in our retrospective study. Age, gender, classification of the pertrochanteric fracture (AO/OTA classification), time to arthroplasty surgery, operative time, total blood loss, and complications were reviewed. The clinical results were evaluated by the ambulatory status, Harris hip score (HHS) and visual analog scale (VAS) score at the second year follow-up. Results: The amount of blood loss and the operative time were significantly higher in the THA group (p=0.001). Post-operative second year VAS score and HHS were similar in both groups (p=0.989 and p=0.820, respectively). There was no significant difference between the two groups in terms of complications rate (p=0.294). Conclusion: Converting to hip arthroplasty is a successful choice in the treatment of cut-out complications following PFN. Both THA and HA groups had similar clinical results, with the HA group being more advantageous regarding cost, operative time, amount of blood loss, and rate of infection. However, the only valid option for those with acetabular defects during cut-out is THA.

Keywords

• Cut-out
• Pertrochanteric Fracture
• Intertrochanteric Fracture
• Proximal Femoral Nailing
• Intramedullary Nailing
• Hip Arthroplasty

Abstract

Amaç: İntertrokanterik fiksasyon cerrahisinin başarısız sonuçlanması sıklıkla ağrı ve fonksiyon kaybına yol açmaktadır. En sık görülen komplikasyon“cut-out” olup, sıklıkla artroplasti ile tedavi edilir. Bu çalışmada, proksimal femur çivileme (PFÇ) cerrahisi sonrası “cut-out” komplikasyonu gelişen olgularda uygulanmış olan total kalça artroplastisi (TKA) ve parsiyel kalça artroplastisi (PKA) sonuçlarını araştırmayı hedefledik. Gereç ve Yöntem: Bu retrospektif çalışmaya, PFÇ sonrası “cut-out” gelişen 40 hasta (20 hasta-TKA, 20 hasta PKA) dahil edildi. Gruplar yaş, cinsiyet, var olan pertrokanterik kırık tipi (AO/OTA sınıflaması ile), artroplastiye geçiş zamanı, ameliyat süresi, toplam kan kaybı ve komplikasyonlar açısından karşılaştırıldı. Klinik sonuçlar hastaların ikinci yıldaki hareket edebilme kabiliyetleri, Harris kalça skoru (HKS) ve görsel analog ölçeği (VAS) skoru kullanılarak elde edildi. Bulgular: TKA grubunda ameliyat süresi ve toplam kan kaybı istatiksel olarak anlamlı bir şekilde daha fazlaydı (p=0,001). Grupların ikinci yıldaki HKS ve VAS skorları benzerdi (p=0,989 ve 0,820). Artroplasti sonrası gelişen komplikasyonlar açısından ise istatistiksel olarak anlamlı fark bulunmadı (p=0,294). Sonuç: PFÇ sonrasında oluşan “cut-out” komplikasyon tedavisinde artroplastiye geçiş başarılı sonuçlar veren bir tedavi seçimidir. Hem TKA hem de PKA grupları benzer klinik sonuçlara sahip olup, PKA maliyeti ameliyat süresi, kan kaybı ve postoperatif enfeksiyon yönünden daha avantajlı görülmektedir. Ancak, asetabulum defekti mevcut olan hastalarda tek geçerli tedavi yöntemi ise TKA’dır.

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