Primary Total Hip Arthroplasty for Gunshot Injury-Induced Secondary Arthritis of the Hip: What Are the Outcomes?

Abstract

Gunshot wound (GSW) injuries around the hip joint can lead to debilitating post-traumatic arthritis, requiring a technically demanding primary total hip arthroplasty (THA). These surgeries are often complicated by bullet debris, extensive scaring, prior operations, and altered local anatomy. Although most literature focuses on acute management of GSW around the hip, a few reports detail the mid-term outcomes of GSW patients with primary THA for post-traumatic arthritis. The purpose of this study was to assess the outcomes and complications associated with THA in nine patients with secondary arthritis due to prior GSW injuries. At a mean follow-up of 35 months (range 12–60 months), significant improvement was shown in hip function, activity, and pain levels, and was similar to the outcomes of 18 patients who underwent primary THA for degenerative joint disease. While technically demanding, THA seems to reduce pain and improve function safely and effectively for patients with GSW-induced hip arthritis.

Keywords

post-traumatic arthritis - gunshot wound - THA

• References

• 1 Dougherty PJ, Vaidya R, Silverton CD, Bartlett C, Najibi S. Joint and long-bone gunshot injuries. J Bone Joint Surg Am 2009; 91 (04) 980-997
• 2 Naziri Q, Issa K, Rizkala A. , et al. Posttraumatic arthritis from gunshot injuries to the hip requiring a primary THA. Orthopedics 2013; 36 (12) e1549-e1554
• 3 Cory JW, Ruch DS. Arthroscopic removal of a. 44 caliber bullet from the hip. Arthroscopy 1998; 14 (06) 624-626
• 4 Kaya I, Ugras A, Saglam N, Sungur I, Cetinus E. Bullet in hip joint. Eurasian J Med 2013; 45 (02) 141-142
• 5 de Madureira PR, De Capitani EM, Vieira RJ. Lead poisoning after gunshot wound. Sao Paulo Med J 2000; 118 (03) 78-80
• 6 Meyer NJ, Thiel B, Ninomiya JT. Retrieval of an intact, intraarticular bullet by hip arthroscopy using the lateral approach. J Orthop Trauma 2002; 16 (01) 51-53
• 7 Sozen YV, Polat G, Kadioglu B, Dikici F, Ozkan K, Unay K. Arthroscopic bullet extraction from the hip in the lateral decubitus position. Hip Int 2010; 20 (02) 265-268
• 8 Rehman MA, Umer M, Sepah YJ, Wajid MA. Bullet-induced synovitis as a cause of secondary osteoarthritis of the hip joint: a case report and review of literature. J Med Case Reports 2007; 1 (01) 171
• 9 Sclafani SJ, Vuletin JC, Twersky J. Lead arthropathy: arthritis caused by retained intra-articular bullets. Radiology 1985; 156 (02) 299-302
• 10 Slavin RE, Swedo J, Cartwright Jr J, Viegas S, Custer EM. Lead arthritis and lead poisoning following bullet wounds: a clinicopathologic, ultrastructural, and microanalytic study of two cases. Hum Pathol 1988; 19 (02) 223-235
• 11 Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network (NHSN) Patient Safety Component Manual. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf . Published 2017. Accessed January 28, 2018
• 12 Kellam P, Ostrum RF. Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 2016; 30 (01) 10-16
• 13 Safran O, Goldman V, Applbaum Y. , et al. Posttraumatic painful hip: sonography as a screening test for occult hip fractures. J Ultrasound Med 2009; 28 (11) 1447-1452
• 14 Lübbeke A, Katz JN, Perneger TV, Hoffmeyer P. Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol 2007; 34 (02) 394-400
• 15 Khurana S, Nobel TB, Merkow JS, Walsh M, Egol KA. Total hip arthroplasty for posttraumatic osteoarthritis of the hip fares worse than THA for primary osteoarthritis. Am J Orthop 2015; 44 (07) 321-325