الفهرس 
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Abstract
A prospective study was conducted involving 20 patients with failed proximal femoral fixation (10 females 50% and 10 males 50%), who underwent conversion hip arthroplasty as a solution of their hip problems, 9 patients had conversion hip replacement on the right side, while 11 patients had it on the left side. Age of the patients has ranged from 21 to 68 years with a mean age of 51.1 years, follow up period had ranged from (3-12) months with an average of 7.5 months. The 20 cases with failed proximal femoral fixation were AVN in 3 cases and nonunion in 12 cases and loss of fixation in 2 cases and osteoarthritic sequel in 2 cases.All patients were clinically assessed according to the Harris hip scoring system pre- and post-operative. At last follow up, the average HHS was 85.7 (ranged from 78 to 93) compared with an average pre-operative HHS of 27.7 (ranged from 18 to 45). Our final result were excellent in 4 cases 20%, good in 14 cases 70%, fair in 2 cases and no poor result.from the above results, it can be seen that hip arthroplasty may be used to treat failed proximal femoral fixation for fractures of the neck femur and trochanteric region with a good result. It can be considered a salvage treatment for these complex cases. The use of bipolar arthroplasty versus total hip arthroplasty in these cases influenced by the age of the patients and healthy acetabulum. Performing the procedure slowly and carefully, attending to every detail, and being warned of the possible complications are enough to allow the surgeon to carefully remove the implant and do hip arthroplasty and reach a satisfactory result. The number of surgical conversion has been growing especially in the last years, Also an alarming number of conversion surgeries must be anticipated due to the increasing Summary and conclusion ١٥٢ number of proximal femoral procedures to the general population. So the aim of this thesis is to give an idea about component selection, surgical technique and reconstructive procedures in conversion surgeries in order to optimize fixation and provide for a complication free recovery.The preoperative planning is of great important to evaluate and assess the bone stock and to determine the suitable prosthesis as well as the method of reconstruction. But the final evaluation of the degree of bone deficiency is decided after metal removal and intra-operative assessment of bone stock.We believe that better results of conversion arthroplasty are correlated with restoration of the original hip centre, restoration of the hip biomechanics and abductor moment arm,and creation of stable construct, this necessitated proper cementation with proper alignment and uniform cement mantle in cemented cases and proper press fit technique in cementless cases.This could explain the relatively better results associated with younger patients. Also it has to be noted that the average follow up by months was 7.5 of which was a relatively short follow up time to access properly the durability of fixation of the implants and although we did not have any aseptic loosening in our study at the last follow up, longer follow up may be needed in order to access the durability of both the cemented and uncemented implants. As a general guideline, older, sicker and patients with lower physical demands may be better treated with simpler operations that restore hip anatomy less completely; where as younger more active patients may be better treated by more complete and anatomic reconstruction.Summary and conclusion١٥٣ Conversion arthroplasty after failed fixation dramatically improve the life of many patients, however this is not free of complications. Adherence to specific basic principles,improving implants and improving operative techniques hopefully will improve the surgeon’s ability to treat these complex problems successfully and with a minimum of complications. In conclusion, salvage arthroplasty after failed proximal femoral fixation is usually more challenging than primary hip arthroplasty. There are greater technical challenges and increased incidence of intra- and postoperative complications. There is no consensus on the long-term outcomes for salvage hip arthroplasty for failed proximal femur fractures, with some studies showing results similar to primary hip replacement while some show a worse outcome in the salvage arthroplasty. There is some indication that the outcomes are better for arthroplasty for failed femoral neck fractures compared with failed intertrochanteric fixation. With an aging population and a high incidence of osteoporosis in the elderly, the incidence of proximal femoral fractures is on the rise. One can expect an increase in the need for salvage arthroplasty when the fixation in some of these procedures fails. Salvage arthroplasty in these cases is more difficult than primary hip replacement and requires specialized techniques.