Clinical Outcomes and Complication Rate after Single-Stage Hardware Removal and Total Hip Arthroplasty: A Matched-Pair Controlled Study

Abstract

Background: Single-stage hardware removal and total hip arthroplasty is a complex surgical procedure, comparable to revision surgery. The purpose of the current study is to evaluate single-stage hardware removal and THA outcomes, compare this technique with a matched control group that has undergone primary THA and assess the risk of periprosthetic joint infection with a 24-month minimum follow-up. Methods: This study included all those cases treated with THA and concomitant hardware removal from 2008 to 2018. The control group was selected on a 1:1 ratio among patients who underwent THA for primary OA. The Harris Hip (HHS) and University of California at Los Angeles Activity (UCLA) scores, infection rate and early and delayed surgical complications were recorded. Results: One hundred and twenty-three consecutive patients (127 hips) were included, and the same number of patients was assigned to the control group. The final functional scores were comparable between the two groups; a longer operative time and transfusion rate were recorded in the study group. Finally, an increased incidence of overall complications was reported (13.8% versus 2.4%), but no cases of early or delayed infection were found. Conclusions: Single-stage hardware removal and THA is a safe and effective but technically demanding technique, with a higher incidence of overall complications, making it more similar to revision THA than to primary THA.

Conversion Birmingham Hip Resurfacing in Managing Post-traumatic Arthritis With Retained Femoral Hardware

“…BHR = Birmingham Hip Resurfacing. it is a technically complex procedure with several associated risks, and less reconstructive options in the future, failure should occur [2][3][4][5][6][7][8][9][10]15,16 .…”

“…Patients, who develop end-stage PTOA unresponsive to nonoperative treatment, are conventionally managed with THA with removal of hardware 14 . While this a viable surgical option, it is a technically complex procedure with several associated risks, and less reconstructive options in the future, failure should occur 2-10,15,16 .…”

“…In post-traumatic osteoarthritis (PTOA) patients with existing hardware that have advanced to end-stage OA, performing a total hip arthroplasty (THA) with hardware removal can be complex 1 . Compared with THA without hardware removal, increased risks associated with this option include infection, increased surgical time, increased blood loss, heightened cost, and refractures at the time of hardware removal 2-12 . In addition, oftentimes proximal bone stock for primary stem fixation can be compromised once the nail is removed, and conversion to a THA can require diaphyseal fixation with revision stems, leaving less option for arthroplasty salvage should future surgery be necessary on the femoral side.…”

Decreased Risk of Periprosthetic Joint Infection with Concurrent Hardware Removal During Conversion Total Hip Arthroplasty Compared to Staged Removal: A Matched Cohort Analysis

“…3 Not only does cTHA with existing hardware confer increased risk of complications, but it is also a more technically challenging procedure and therefore is important to fully understand and investigate. 4 Although it is clear that previous hardware increases the risk of adverse events following cTHA, it is unclear as to the optimal timing by which to perform hardware removal with hip arthroplasty. Proponents of staged hardware removal justify staged cTHA such that the femoral bone can regain vascularity before arthroplasty.…”

“… 3 Not only does cTHA with existing hardware confer increased risk of complications, but it is also a more technically challenging procedure and therefore is important to fully understand and investigate. 4 …”