Comparative Outcomes of Early Versus Late Conversion to Total Hip Arthroplasty Following Hip Fracture Fixation
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Published on: September 7, 2022
Jackson P Tate1, Nolan M Reinhart1, Chauncey A Bridges1
1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Insights
Early conversion total hip arthroplasty (THA) within one year of hip fracture fixation leads to significantly higher complication rates, including infection and reoperation, compared to late conversion THA.
Area of Science:
- Orthopaedic Surgery
- Arthroplasty
- Trauma Surgery
Background:
- Hip fractures are common and lead to significant morbidity and mortality.
- Conversion total hip arthroplasty (THA) after failed primary hip fracture fixation is complex.
- High complication rates are associated with conversion THA, but early vs. late timing is understudied.
Purpose of the Study:
- To compare complication rates between early (within 1 year) and late (after 1 year) conversion THA.
- To determine if early conversion THA is associated with increased risks.
Main Methods:
- Retrospective cohort study using an administrative claims database.
- Identified 1,205 early and 6,455 late conversion THA patients based on time from primary fixation.
- Compared joint complications (2 years) and medical complications (90 days) using multivariable logistic regression.
Main Results:
- Early CTHA showed higher rates of reoperation (8.3% vs 5.1%), periprosthetic infections (7.1% vs 5.2%), fractures (5.4% vs 2.6%), mechanical issues (5.2% vs 3.1%), and dislocations (7.7% vs 3.9%).
- Overall orthopaedic complications were 19.4% in early CTHA versus 12.4% in late CTHA.
- Early CTHA patients had higher rates of deep vein thrombosis, transfusions, and hospital readmission.
Conclusions:
- Early conversion THA is linked to significantly higher rates of both joint and medical complications.
- Understanding these risks is crucial for surgeon preparation and patient counseling regarding prognosis and recovery.
- Timing of conversion THA significantly impacts patient outcomes and complication profiles.
Background:
Hip fractures are prevalent orthopaedic injuries with substantial morbidity and mortality. Failed primary treatments of these fractures often necessitate conversion to total hip arthroplasty (THA), a complex procedure requiring extensive exposure and hardware removal. It poses major challenges and is associated with high rates of complications such as infection, dislocation, and periprosthetic fractures. Despite the documented risks, there are limited data comparing complication rates between early (within 1 year) and late (after 1 year) conversion THA (CTHA). This study aimed to compare early and late CTHA and hypothesized that early CTHA was associated with higher complication rates than late CTHA.
Methods:
A retrospective cohort study was conducted using an administrative claims database. The time from primary fixation of the proximal femur fracture to CTHA was used to identify patients who underwent early (n = 1,205) and late (n = 6,455) CTHA. Rates of joint complications within 2 years and medical complications within 90 days postoperatively were compared using multivariable logistic regressions.
Results:
Early CTHA patients exhibited significantly higher rates of reoperation (8.3 versus 5.1%; odds ratio [OR]: 1.72), periprosthetic infections (7.1 versus 5.2%; OR: 1.50), periprosthetic fractures (5.4 versus 2.6%; OR: 1.73), mechanical complications (5.2 versus 3.1%; OR: 1.60), and dislocations (7.7 versus 3.9%; OR: 1.97). Overall, 19.4% of early conversion patients experience an orthopaedic complication, compared to 12.4% of late conversions. Medical complications within 90 days included higher rates of deep vein thrombosis in early CTHA patients (1.7 versus 0.8%; OR: 1.99), transfusions (5.6 versus 3.1%; OR: 1.50), and hospital readmission (13.9 versus 9.3%; OR: 1.39).
Conclusions:
Early CTHA was associated with higher rates of complications compared to late conversion. Understanding these risks allows surgeons to better prepare patients for the surgery and ensure that patients have a realistic understanding of their prognosis and are adequately prepared for the challenges of recovery.
