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Comparison of Differences in Complications and Revision After Conversion to Total Hip Arthroplasty from Plating vs.
Senthil Sambandam1, Varatharaj Mounasamy2, Dane Wukich2
1University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, Texas.
Insights
Total hip arthroplasty (THA) after prior hip surgery poses increased complexity. Conversion from hemiarthroplasty to THA shows higher infection and revision risks, urging caution in patient selection.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Complication Analysis
Background:
- Previous hip surgery complicates total hip arthroplasty (THA).
- Investigating complication rates of THA conversion from prior hip procedures.
- Examining THA after intertrochanteric fracture fixation (plate or nail) and hemiarthroplasty.
Purpose of the Study:
- To compare complication rates of THA following three specific prior hip surgeries.
- To evaluate risks including transfusion, surgical site infection (SSI), periprosthetic fracture, dislocation, and revision.
- To contrast these risks against primary THA complication rates.
Main Methods:
- Retrospective study using the PearlDiver database (2010-2019).
- Included patients undergoing THA with prior hemiarthroplasty, plate fixation (CPT 27444), or nail fixation (CPT 27445) within two years.
- Compared complication rates to 117,936 primary THA patients.
Main Results:
- Nailing group showed highest transfusion risk (OR=2.34).
- Hemiarthroplasty group had the highest SSI risk (OR=9.25) and 2-year revision risk (OR=10.53).
- Specific CPT codes were used for procedure identification.
Conclusions:
- Conversion from hemiarthroplasty to THA is linked to increased infection and revision risks.
- Surgeons should be cautious with primary hemiarthroplasty for severe fractures, especially in active elderly patients.
- This highlights the importance of careful pre-operative planning for revision THA.
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, Colorado Springs) and identified all patients undergoing THA between 2010 and 2019. Among this group, we included all patients who had received one of the three procedures , hip hemiarthroplasty (CPT 27125), fixation of the intertrochanteric fracture with plates and screws (CPT 27444), or fixation of hip fracture with nail (CPT 27445) 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 30-day transfusion risk, 90-day surgical site infection (SSI) risk, 90-day periprosthetic fracture risk, 1-year dislocation risk, and 2-, 5-, and 10-year revision risk.
Results:
A total of 118,209 patients underwent THA between 2010 and 2019. A total of 9,173, 48,326, and 31,632 patients underwent fixation with plates and screws , nailing and hemiarthroplasty respectively. We identified 71, 42, and 160 patients with hemiarthroplasty, plates & screws, and nailing, respectively, within two years of THA. 117,936 primary THA patients were used as a comparison group. The nailing group had the highest rate of transfusion risk (OR=2.34, 95% CI=1.32, 4.13, P<0.05).Furthermore, the hemiarthroplasty group had highest rate of SSI risk (OR=9.25, 95% CI=4.86, 17.63, P<0.05) and highest revision risk at 2 years (OR=10.532, 95% CI= 6.09, 18.19, P<0.05).
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.
