Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years

Abstract

BackgroundConversion to total hip arthroplasty (CTHA) is a relatively common procedure after a failed dynamic hip screw (DHS) or proximal femoral nail anti-rotation (PFNA) fixation of intertrochanteric fractures, but there have been far fewer reports specifically describing the long-term results of CTHA after failed treatments of stable intertrochanteric fractures with DHS or PFNA. The aim of the present study was to compare the clinical and radiological outcomes of CTHA after failed PFNA or DHS fixations of stable intertrochanteric fractures after a minimum follow-up of 3 years.MethodsBetween January 2005 and April 2014, we retrospectively reviewed 142 active elderly patients treated at our institution (a single institution study). A total of 72 patients (72 hips; 41 women, 31 men; mean age 76.9 years old; range 60–92 years old) who underwent conversion of a failed PFNA to a THA were compared with 70 patients (70 hips; 36 women, 34 men; mean age 75.0 years old; range 60–90 years old) who underwent CTHA after a failed DHS fixation. The mean follow-up periods were 48 (range 43–52) and 48 (range 44–52) months for the DHS and PFNA groups, respectively. Clinical and radiologic evaluations were performed on all patients. The primary outcome was the Harris Hip Score (HHS). The secondary outcomes were the complication rates.ResultsThe Harris Hip Score (HHS) improved from 50.61 ± 3.23 preoperatively to 85.28 ± 4.45 at the last follow-up in the PFNA group and from 51.46 ± 3.90 to 84.50 ± 4.34 in the DHS group, with no significant differences noted between the groups at each follow-up (P > 0.05). However, the complication rate in the converted DHS patients was significantly higher (42.9%) than that in the converted PFNA patients (20.8%; P = 0.003). Thirty-seven PFFs (2.4%) occurred during a mean follow-up of 44.4 months. The incidence of periprosthetic fractures was found to be significantly higher (P = 0.021) for the DHS group (15.7%) than for the PFNA group (4.2%).ConclusionsCTHA after failed DHS fixations of stable intertrochanteric fractures might be associated with a significantly higher complication rate than CTHA after failed PFNA fixations. Therefore, PFNA patients with stable intertrochanteric fractures may be more suitable for CTHA.

Cemented versus uncemented total hip arthroplasty for failed proximal femoral nail anti-rotation fixation in patients with intertrochanteric femur fractures: 5-year results of a retrospective observational study

“…The conversion procedure was carried out as stated by the manufacturers' instructions at three medical institutions by 6 surgeons, who were all experienced in arthroplasty. The technical details and postoperative protocol have been reported in our prior study [2]. The inclusion criteria were as follows: active elderly patients aged ≥ 60 years old; patients with a prior IFF (Type AO/OTA 31.…”

“…Therapeutic advances in proximal femoral nail anti-rotation (PFNA) have substantially improved the outcomes for an increasing number of patients with a clinical diagnosis of intertrochanteric femur fractures (IFFs), a subtype of proximal femoral fractures, which was previously associated with poor prognoses [1][2][3]. The number of IFFs treated with PFNA during the past decade has increased dramatically and will substantially increase, not only as a consequence of an ageing population but also owing to its increasing use in young patients [4,5].…”

“…The number of IFFs treated with PFNA during the past decade has increased dramatically and will substantially increase, not only as a consequence of an ageing population but also owing to its increasing use in young patients [4,5]. Hence, the number of failed PFNA that requires revision procedures may also increase accordingly [2]. Regrettably, the available options for revising a failed PFNA are limited [2].…”

“…Hence, the number of failed PFNA that requires revision procedures may also increase accordingly [2]. Regrettably, the available options for revising a failed PFNA are limited [2]. When a failed PFNA intervention is indicated, the treatment strategies remain challenging and controversial [1].…”

Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study

“…In recent years, the incidence of femoral neck fractures has significantly increased given the growth of the aging population. 1 , 2 Total hip arthroplasty (THA) remains one of the most efficacious reconstructive orthopaedic procedures for most elderly patients with osteoporosis who sustain femoral neck fractures. 1 Neither anticoagulant therapy nor routine anticoagulation laboratory monitoring obviate the need to prevent the occurrence of lower extremity venous thrombosis.…”