Total hip arthroplasty for head and neck of femur fractures secondary to civilian gunshot injuries.
Maqungo S., Nicol A., Nortje M., Gamieldien W., Graham S., Laubscher M., Berry K.
BACKGROUND: The optimal treatment for intracapsular neck of femur fractures secondary to civilian gunshot injuries (GSI) remains a challenge. Surgical fixation is associated with a high failure rate due to avascular necrosis and non-union. This manuscript reports on the largest series of patients who underwent total hip arthroplasty (THA) for civilian GSI involving the hip joint. The objectives are to assess clinical outcomes and to report on complications as well as associated injuries. METHODS: All patients who had undergone THA for a civilian GSI to the hip joint at a single Level 1 Trauma Centre from 2009 -2022 were included. Patients with incomplete clinical records were excluded. RESULTS: A total of 14 patients were identified, and all were males with an average age of 32 years (range 18-49). The mean follow-up time was 20 months (range 2 - 108). Ten of these patients received acute primary THA, whilst 4 had delayed THA for failed open reduction and internal fixation. The average time to surgery for the acute group was 7,6 days (range 3 - 14) and for the delayed group it was 39 months (range 10 - 120). Visceral injuries, mostly bowel and bladder, and other pelvis ring fractures, were the most commonly encountered associated injuries. One patient (7%) developed prosthetic joint infection (PJI) within 2 weeks of acute primary THA, despite negative microbiological samples obtained at index THA. He had associated large bowel injury, caused by a different projectile with no direct communication with the hip joint. No patients presented with PJI in the delayed group. In the delayed THA cohort, the mean pre-operative Harris Hip Score (HHS) was 53.2 points, and the mean postoperative HHS at 6 months was 85.5 points. CONCLUSION: Total hip arthroplasty is a safe and feasible option for these complex injuries that carry poor surgical fixation outcomes. THA can be performed both in the acute setting, or in a delayed manner following failed surgical fixation.