Conversion total hip arthroplasty: a reason not to use cephalomedullary nails

Previous studies have yet to compare outcomes of conversion to hip arthroplasty from screw and side plate vs cephalomedullary nail. Seventy-six patients at our institution underwent hip conversion after fixation failure. We performed a retrospective chart review to compare perioperative outcomes in these 2 groups. Both operative time (P = .020) and blood loss (P = .041) were significantly greater in patients converted from cephalomedullary nail. Greater length of stay in this group trended to significance (P = .101). Perioperative complications were similar. Recent practice patterns reveal a dramatic increase in the use of cephalomedullary nails despite lack of evidence suggesting their clinical superiority in certain fracture patterns. Our results suggest that conversion to total hip arthroplasty after internal fixation with cephalomedullary nail is a more complex procedure than is conversion from screw and side plate. The surgeon should consider possible later hip conversion and these results when choosing the appropriate fixation implant.