Orthopedic Hardware Type Impacts Case Complexity in Conversion Total Hip Arthroplasty Surgery

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Outcomes Research

Background:

• Conversion total hip arthroplasty (THA) involves diverse prior implants, influencing procedure complexity and outcomes.
• Pre-existing proximal femur fixation, such as intramedullary nails (IMNs) or screw fixation, presents unique challenges for subsequent THA.

Purpose of the Study:

• To compare the surgical complexity and resource utilization of conversion THA in patients with prior intramedullary nails (IMNs) versus screw fixation.
• To evaluate perioperative outcomes and identify differences between these two distinct patient groups undergoing conversion THA.

Main Methods:

• Retrospective review of 106 patients undergoing conversion THA between 2012 and 2020.
• Patients were categorized based on preoperative fixation: intramedullary nails (IMNs) or closed reduction and percutaneous pinning/screw fixation (CRPP).
• Collected data included demographics, operative details, outcomes, and implant information.

Main Results:

• No significant differences in age or BMI between IMN and CRPP cohorts.
• IMN patients underwent more prior surgeries, experienced increased blood loss, and had longer operative times.
• IMN cohort showed longer hospital stays, higher rates of trochanteric plate use, readmissions, and need for revision surgery compared to CRPP.

Conclusions:

• Conversion THA following intramedullary nail (IMN) fixation is associated with significantly worse perioperative outcomes compared to conversion following screw fixation (CRPP).
• These findings highlight distinct clinical and resource implications for managing patients with prior IMNs versus CRPP constructs during conversion THA.