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INTRODUCTION: Failure of hip implant surgeries can be caused by various factors. Failure of internal fixation results in pain and restricted ambulation. In management of an elderly patient with hip fractures, the aim is to ambulate patient. The purpose of our study is to assess the outcomes of proximal femur replacement in the management of failed hip surgeries for fractures of the proximal femur. MATERIALS AND METHODS: A retrospective analysis of 26 patients, who underwent proximal femur replacement for failed surgeries of hip fracture during the period from April 2011 to March 2018, was conducted. All patients who underwent proximal femur replacement for failed hip implants were enrolled into the study. RESULTS: Total patients were 26. The mean follow was (12-91 months). The mean Harris Hip score improved from 26 preoperative to 66.7(45-91). Three patients developed dislocations which were managed with closed reduction. Three patients died within one year of surgery, one patent died of sepsis from implant infection at four months after surgery, one patient died of Myocardial infarction. Three patients developed surgical site infection of which one has superficial surgical site infection which was managed with oral antibiotics, in other case developed deep surgical site infection and was managed with wound debridement and IV antibiotics for 6 weeks, in third wound debridement was done but patient died of sepsis. CONCLUSION: Proximal femur replacement with modular stem implant has advantages over conventional hip implant in patients undergoing surgery after failure of internal fixation.
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BACKGROUND: Aggressive fibromatosis or desmoid fibromatosis is a soft tissue neoplasm which is non-metastatic in nature. Among all soft tissue tumours, it comprises of 3% cases and is more common in females as compared to males. Objective of our study was to evaluate the treatment outcomes of extra abdominal fibromatosis in patients who were treated in our setup and determine the recurrence patterns. METHODS: It is retrospective cohort of 15 patients that were treated in section of Orthopaedics, department of surgery, Aga Khan University hospital, Karachi from January 1990 to December 2015. It included all adult patients of age >18 years with biopsy proven extra abdominal aggressive fibromatosis. Data was analysed on SPSS 22 version.. RESULTS: Out of 15 patients, there were 7 males (46.7%) and 8 females (53.3%). Median age was 22 years. Majority of patients [10 (66.6%)] had upper limb lesion. On initial biopsy we had 11 (73.3%) cases of primary fibromatosis while 2 (13.3%) were recurrent and 2 (13.3%) were spindle cell carcinoma. The median (IQR) follow-up time of the participants was 3 (2-3) months. Complications occurred in 8 (53.3%) patients. A significant difference was observed in the haemoglobin levels before and after surgery with a mean difference of 2.74 (p-value<0.001). Recurrence of disease occurred in 4 (26.7%) patients and all of these patients who had recurrence underwent 2nd surgery versus 1 of the participants who had second surgery without recurrence and this was a significant difference (p value <0.004). CONCLUSION: Extra abdominal fibromatosis is commonly found among younger age groups, affecting females more as compared to males. Less than half of the patients had recurrence of disease in our study and intra-operative and postoperative complications are common surgical outcomes and our study results are compatible with previously reported literature.
