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Outcome of hemiarthroplasty to total hip arthroplasty conversion: a systematic review
S Ansari1, T Gupta1, J Pranav2
1Department of Orthopaedics, All India Institute of Medical Sciences, Kalyani, India.
Insights
Conversion total hip arthroplasty after hemiarthroplasty shows improved function but higher complication risks. Patients experienced better hip scores, though dislocation and infection rates increased post-surgery.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Biomedical Engineering
Background:
- Hemiarthroplasty is a common treatment for hip fractures.
- Conversion total hip arthroplasty (THA) is performed after hemiarthroplasty failure.
- Conversion THA may have higher complication rates than primary THA.
Purpose of the Study:
- To systematically review the outcomes of conversion THA following failed hemiarthroplasty.
- To synthesize data on complication rates in conversion THA.
- To compare outcomes with primary THA.
Main Methods:
- Systematic literature review of 15 studies.
- Searched PubMed, EMBASE, Scopus, and Cochrane databases.
- Included 3432 hips for analysis.
Main Results:
- Pain and acetabular erosion were primary indications for conversion.
- Mean Harris Hip Score improved significantly post-conversion (45.74 to 84.03).
- Mean survivorship was 97.21% at 5-6 years; prosthetic joint infection was the most common complication.
Conclusions:
- Conversion THA leads to higher odds of dislocation, infection, fracture, and loosening compared to primary THA.
- Complication rates increased significantly between 1- and 2-year follow-ups.
- Careful patient selection and surgical technique are crucial for conversion THA outcomes.
Purpose:
A systematic review of the literature was performed in order to synthesize the available data on the outcome of conversion total hip arthroplasty after failed hemiarthroplasty keeping in mind the higher complication rates of conversion as compared to a primary total hip arthroplasty.
Methods:
Comprehensive search of literature was performed for the systematic review through online databases-PubMed, EMBASE, Scopus, and the Cochrane database. The abstracts were identified first by the above-mentioned search methods and were assessed for eligibility based on strict criteria. 15 studies regarding conversion hemiarthroplasty were finally included for the study.
Results:
The 15 studies evaluating 3432 hips revealed that the main indication for conversion to arthroplasty was pain in the groin or thigh symptomatically and acetabular erosion with well-fixed femoral stem (455 cases; 13.25%) radiologically. Majority of the cases were revised in a single stage (292 cases) as compared to 25 cases revised in 2-stage surgery mostly owing to infection. The mean pre-conversion Harris Hip Score (HHS) improved from 45.74 to 84.03 in the post-conversion time. Majority of the conversions constituted cemented fixation for the femoral component and uncemented fixation for the acetabular component. Mean survivorship was found to be 97.21% at 5-6 years. The conversions were most commonly complicated by prosthetic joint infection most commonly which was managed by long-term antibiotics and/or debridement with or without exchange of implants.
Conclusion:
The conversion group had consistently higher odds of prosthetic joint dislocation, prosthetic joint infection, periprosthetic fracture, aseptic loosening and revision both at 1- and 2-year follow-ups. It was also noteworthy that the odds of developing these complications increased significantly from 1-year follow-up to the 2 years follow-up.
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