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Outcomes of conversion total hip arthroplasty following previous hip fracture surgery
Amr Selim1,2, Debashis Dass3, Siddharth Govilkar3
1The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
Insights
Conversion of previous hip fracture surgery to total hip arthroplasty (CTHA) presents challenges but yields good medium-term outcomes. While complication rates are higher than conventional total hip arthroplasty (THA), CTHA offers improved hip function.
Area of Science:
- Orthopaedic Surgery
- Arthroplasty
- Hip Reconstruction
Background:
- Conversion of hip fracture surgery to total hip arthroplasty (CTHA) is complex.
- Outcomes and complication rates for CTHA are variable and not well-established.
Purpose of the Study:
- To determine the medium-term survival and functional outcomes of CTHA after prior hip fracture surgery.
- To identify complications associated with CTHA in this patient cohort.
Main Methods:
- Retrospective review of 167 CTHA procedures performed between 2008 and 2020.
- Clinical follow-up included Oxford Hip Scores (OHS); radiological assessment and review of complications and revision rates.
Main Results:
- 166 patients (mean age 71) underwent CTHA. Mean follow-up was 4 years.
- Complications occurred in 8.4% of patients, with intraoperative fractures and dislocations being most common.
- Survival probability was 96% (cemented) and 88% (uncemented) at ~9.5 years. OHS improved significantly in both groups.
Conclusions:
- CTHA following hip fracture surgery has higher complication rates than conventional THA.
- Good medium-term functional results and survival can be achieved with CTHA.
- NJR classification needs review to account for CTHA's increased complication potential.
Aims:
The conversion of previous hip fracture surgery to total hip arthroplasty (CTHA) can be surgically challenging with unpredictable outcomes; reported complication rates vary significantly. This study aimed to establish the medium-term survival and outcomes of CTHA performed following a previous hip fracture surgery.
Methods:
All CTHAs performed at our tertiary orthopaedic institution between January 2008 and January 2020 following previous ipsilateral hip fracture surgery were included. Patients were followed up clinically using Oxford Hip Scores (OHS), and radiologically until death or revision surgery. Postoperative complications, radiological implant failure, and indications for revision surgery were reviewed.
Results:
A total of 166 patients (167 hips) were included in the study, with a mean age of 71 years (42 to 99). Of these, 113 patients (67.7%) were female. CTHA followed cannulated screw fixation in 75 cases, hemiarthroplasty in 18, dynamic hip screw fixation in 47, and cephalomedullary nail in 27 cases. Patients were followed up for a mean of four years (0.1 to 9.3). During the follow-up period, 32 patients (19.2%) died. Overall, 14 patients (8.4%) suffered a complication of surgery, with intraoperative fractures (4.2%) and dislocations (3.6%) predominating. The survival probability was 96% at 9.53 years in the cemented group and 88% at 9.42 years in the uncemented group (p = 0.317). The median OHS improved from 13 (IQR 7.75 to 21.25) preoperatively to 39 (IQR 31 to 45) postoperatively in the uncemented group, and from 14 (IQR 10.5 to 22) to 38 (IQR 27 to 45) in the cemented group.
Conclusion:
This study highlights that CTHA from hip fracture surgery is associated with higher complication rates than conventional THA, but good medium-term results can be achieved. Their classification within the NJR requires review, acknowledging the increased potential for complications.
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