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Differences in Perioperative Outcomes Between Conversion Total Hip Arthroplasty After Previous Proximal Femur
Brook Biniam1, Jonathan Bourget-Murray1,2, Paul Beaulé1
1Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Background:
This study compares outcomes between conversion total hip arthroplasty (THA) after proximal femur fracture (PFF) fixation and primary THA for osteoarthritis and examines whether fracture type affects results.
Methods:
This is a retrospective review of prospectively collected data from a single academic center. Eighty-seven consecutive patients underwent conversion THA following surgical fixation of a PFF with a minimum 2-year follow-up. These patients were matched 1:1 with patients who underwent a primary THA for osteoarthritis, by the same arthroplasty surgeons, using propensity score technique. Outcomes measures included length of stay, complications, reoperation rates, and Oxford Hip Score (OHS). Subgroup analysis involved comparing outcome measures between patients who required conversion THA following an intracapsular and extracapsular PFF.
Results:
The mean follow-up was 5.6 years (range, 2.3-13.1). Patients in the conversion THA group required longer length of stay (8.1 vs 1.4 days, P < .001). There was no difference in complication rate (12.6% vs 16.1%, P = .491), reoperative rate (12.6% vs 5.7%, P = .243), or OHS (40.1 vs 37.2; P = .052) at final follow-up. There was no difference in outcomes between controls and conversion THA for a previous intracapsular PFF. Reoperation rate was significantly higher (18.2% vs 5.7%, P = .039) and OHS significantly lower (32.3 vs 40.0, P < .001) for conversion THA following extracapsular PFF.
Conclusions:
Conversion THA after extracapsular PPF is associated with higher reoperation rates and poorer functional outcomes than primary THA for osteoarthritis. In contract, intracapsular PPF show comparable results, underscoring the need to consider fracture type in treatment planning.
