Increased Complication Rate Following Conversion Total Hip Arthroplasty After Cephalomedullary Fixation For Intertrochanteric Hip Fractures

Pui, Christine M.; Bostrom, Mathias P.; Westrich, Geoffrey H.; Valle, Craig J. Della; Macaulay, William; Mont, Michael A.; Padgett, Douglas E.

doi:10.1016/j.arth.2013.04.048

Cited by 62 publications

(52 citation statements)

References 17 publications

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“…Despite these potential advantages of intramedullary fixation, recent evidence suggests that there may be more complications after conversion to total hip arthroplasty from failed intramedullary than from failed extramedullary fixation 24 .…”

Section: Discussionmentioning

confidence: 99%

Extramedullary Compared with Intramedullary Implants for Intertrochanteric Hip Fractures

Bohl

Basques

Golinvaux

et al. 2014

The Journal of Bone and Joint Surgery

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These results reinforce the results of previous randomized trials, demonstrating little difference in rates of general surgical adverse events between implant types. The present study presents an important departure from previous trials in its finding that patients treated with intramedullary implants have, on average, a shorter postoperative length of stay (by 1.1 days). The finding may negate the perceived excess cost associated with intramedullary treatment. Limitations regarding the ACS NSQIP database include a lack of detail regarding fracture subtype, outcomes beyond thirty days, and orthopaedic-specific outcomes.

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Section: Discussionmentioning

confidence: 99%

Extramedullary Compared with Intramedullary Implants for Intertrochanteric Hip Fractures

Bohl

Basques

Golinvaux

et al. 2014

The Journal of Bone and Joint Surgery

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“…Conversion after nailing puts the patient at higher risk of greater trochanter fracture, abductor deficiency, limp, and dislocation. 102 Stem selection can be based on surgeon preference but should have some sort of distal fixation for conversion after Sliding hip screw (SHS) or Intramedullary nail (IM) nail devices. The stem can be cemented or uncemented.…”

Section: Conversion To Arthroplastymentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

132

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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“…It is reasonable to expect this difference in pain level and HHS to increase with length of follow-up after salvage arthroplasty based on the aforementioned literature. Published outcomes data have shown comparable improvements in HHS between cTHA performed for failed sliding hip screw and cephalomedullary nail constructs at a 3-year follow-up [38]. Although THA addresses acetabular cartilage damage and the need for implant longevity in some patients, longer operating times and increased blood loss can be expected for THA compared with HA [33], [36].…”

Section: Discussionmentioning

confidence: 97%

Salvage of failed internal fixation of intertrochanteric hip fractures: clinical and functional outcomes of total hip arthroplasty versus hemiarthroplasty

et al. 2018

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BackgroundFailed internal fixation of intertrochanteric (IT) hip fractures presents a significant challenge in the elderly, osteoporotic population. Conversion total hip arthroplasty (cTHA) and hemiarthroplasty (cHA) are both accepted salvage operations for failed IT fracture fixation, though limited clinical data exist regarding the optimal treatment between these procedures.MethodsA systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were English-language studies that compared clinical or functional outcomes after failed fixation of IT fractures with total hip arthroplasty and hemiarthroplasty in adult subjects (>18 years of age). Data regarding research design, surgical technique, and clinical or functional outcomes were obtained and analyzed from eligible studies using a Mantel-Haenszel random-effects analysis model.ResultsSix studies with 188 patients (100, total hip arthroplasty; 88, hemiarthroplasty) met inclusion and exclusion criteria. There was no significant difference between cTHA and cHA for postoperative dislocation, reoperation, infection, intraoperative fractures, postoperative fractures, or stem subsidence. The mean change in Harris Hip Scores was significantly higher (P < .001) in the cTHA group (47.5 ± 4.9) than that in the cHA (38.9 ± 7.2) group at minimum 14-month follow-up.ConclusionsDespite potential advantages of cTHA or cHA for failed IT fractures, there were no differences in complications between either of the salvage procedures. Our analysis found a slight advantage in functional outcomes (Harris Hip Score) for cTHA at a minimum 14-month follow-up. Our study suggests that cTHA and cHA are both effective salvage procedures. Additional prospective studies are warranted to further delineate outcomes after salvage arthroplasty performed for failed IT fracture fixation.

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Increased Complication Rate Following Conversion Total Hip Arthroplasty After Cephalomedullary Fixation For Intertrochanteric Hip Fractures

Cited by 62 publications

References 17 publications

Extramedullary Compared with Intramedullary Implants for Intertrochanteric Hip Fractures

Extramedullary Compared with Intramedullary Implants for Intertrochanteric Hip Fractures

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Salvage of failed internal fixation of intertrochanteric hip fractures: clinical and functional outcomes of total hip arthroplasty versus hemiarthroplasty

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