الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Failed treatment of a proximal femur fracture typically leads to profound functional disability and pain. Treatment with repeated attempts to gain union and to preserve the host femoral head usually is preferred for young patients, but salvage treatment with hip arthroplasty may be considered for selected older patients with poor bone quality, bone loss, or articular cartilage damage.In the elderly patients, arthroplasty has some advantages; fracture fixation does not need to be considered, the biomechanics of the hip can be more readily restored, and the patients can be mobilized quickly without the need for external supports for long periods. Many patients demonstrated clinically significant pain relief and return to ambulation following bipolar hemiarthroplasty or total hip arthroplasty using modular proximal femoral replacements with long stem prosthesis to bypass the stress risers and the weak proximal bone. A calcar-replacing stem is needed but may be used when the medial cortex is absent. Earlier intervention after failed trochanteric internal fixation should be recommended so that prolonged disability could be avoided.Despite the operative challenges, surprisingly few serious orthopaedic complications and many specific problems may occur. The surgery takes longer because the internal fixation device first must be removed. The blood loss is increased because the surgeon must dissect through the old scar to expose the internal fixation device. The anatomy of the proximal femur usually is distorted, especially if the reduction of the intertrochanteric fracture is imperfect, or if there is comminution of the medial bony buttress. The bone quality usually is poor as a result of pre-existing osteoporosis, which further decreases as a result of disuse after the failure of internal fixation. The greater trochanter either is not solidly healed or can be fragmented again during the hip arthroplasty, thus affecting the abduction function, which leads to an increased dislocation rate and can adversely affect the ambulatory function after the hip arthroplasty.