Comparison of Differences in Complications and Revision After Conversion to Total Hip Arthroplasty from Plating vs. Nailing vs. Hemiarthroplasty

Background: Total hip arthroplasty (THA)after previous hip surgery increases the procedure complexity and complication rate. We investigated the complication rates following conversion to total hip arthroplasty from three hip surgeries, namely plate fixation of the intertrochanteric fracture, nailing of the trochanteric fracture, and hemiarthroplasty of the hip.Methods: This retrospective study was conducted using the PearlDiver database (www.pearldiverinc.com, ColoradoSprings) and identified all patients undergoing THA between ۲۰۱۰ and ۲۰۱۹. Among this group, we included all patients who had received one of the three procedures , hip hemiarthroplasty (CPT ۲۷۱۲۵), fixation of the intertrochanteric fracture with plates and screws (CPT ۲۷۴۴۴), or fixation of hip fracture with nail (CPT ۲۷۴۴۵) within two years of THA. We analyzed complications in these patients and compared it to the complication rate in primary THA patients. The complications analyzed were ۳۰-day transfusion risk, ۹۰-day surgical site infection (SSI) risk, ۹۰-day periprosthetic fracture risk, ۱-year dislocation risk, and ۲-, ۵-, and ۱۰-year revision risk. Results: A total of ۱۱۸,۲۰۹ patients underwent THA between ۲۰۱۰ and ۲۰۱۹. A total of ۹,۱۷۳, ۴۸,۳۲۶, and ۳۱,۶۳۲ patients underwent fixation with plates and screws , nailing and hemiarthroplasty respectively. We identified ۷۱, ۴۲, and ۱۶۰ patients with hemiarthroplasty, plates & screws, and nailing, respectively, within two years of THA. ۱۱۷,۹۳۶ primary THA patients were used as a comparison group. The nailing group had the highest rate of transfusion risk (OR=۲.۳۴, ۹۵% CI=۱.۳۲, ۴.۱۳, P<۰.۰۵).Furthermore, the hemiarthroplasty group had highest rate of SSI risk (OR=۹.۲۵, ۹۵% CI=۴.۸۶, ۱۷.۶۳, P<۰.۰۵) and highest revision risk at ۲ years (OR=۱۰.۵۳۲, ۹۵% CI= ۶.۰۹, ۱۸.۱۹, P<۰.۰۵).Conclusion: Conversion of hemiarthroplasty to THA was associated with a higher risk of infection and revision. Hence, surgeons considering primary hip hemiarthroplasty for severely comminuted intertrochanteric fracture should exercise caution, especially for active elderly patients.Level of evidence: III

Keywords:

Cephalomedullary nailing , complication , Conversion hip , Hemiarthroplasty , Plating , Revision