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Related Experiment Video

Updated: Sep 14, 2025

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
04:41

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

Published on: June 6, 2025

241

Conversion Total Hip Arthroplasty After Intramedullary Nailing: Outcomes Based on Surgical Approach.

Scott A Muffly1, Devon R Pekas2, Mehmet E Kilinc2

  • 1Sports Medicine & Orthopaedic Center, Chesapeake, Virginia.

The Journal of Arthroplasty
|July 19, 2025
PubMed
Summary

Conversion total hip arthroplasty (cTHA) after femoral intramedullary nail (IMN) fixation shows no significant outcome difference between direct anterior (DAA) and postero-lateral (PLA) approaches. Surgeon experience and patient factors should guide approach selection.

Keywords:
conversion total hip arthroplastydirect anterior approachfemoral intramedullary nailpost-traumatic osteoarthritispostero-lateral approach

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Area of Science:

  • Orthopaedic Surgery
  • Arthroplasty
  • Trauma Surgery

Background:

  • Increasing incidence of conversion total hip arthroplasty (cTHA) after femoral intramedullary nail (IMN) fixation.
  • Limited understanding of surgical approach impact on cTHA outcomes post-IMN.

Purpose of the Study:

  • Compare outcomes of cTHA after IMN using direct anterior approach (DAA) versus postero-lateral approach (PLA).

Main Methods:

  • Retrospective review of 60 cTHA after IMN cases (November 2009 - August 2023).
  • Comparison of outcomes between DAA (24 patients) and PLA (36 patients) conversions.
  • Data collected included demographics, operative details, and postoperative outcomes.

Main Results:

  • Postero-lateral approach (PLA) associated with higher estimated blood loss (P < 0.05).
  • No significant differences observed in surgical time, transfusion rates, length of stay, infection, or revision rates between DAA and PLA.
  • Similar rates for periprosthetic fractures, dislocations, and 90-day adverse events (readmission, reoperation, ED visits, mortality).

Conclusions:

  • Neither DAA nor PLA demonstrates superiority for cTHA outcomes after IMN in this institutional experience.
  • Approach selection should be individualized based on surgeon expertise, patient factors, and specific surgical considerations.