Conversion hip arthroplasty as a salvage procedure after pertrochanteric fracture fixation failure is associated with higher rates of surgical complications due to patient comorbidities, poor bone stock, pseudoarthrosis of greater trochanter and insufficient hip abduction mechanism.
In our retrospective study ranging from January 2014 to October 2024, we identified 29 (0,5%) out of a total of 4853 cases that required conversion hip arthroplasty after pertrochanteric fracture fixation. Indications for conversion were cut-out (10 patients, 34%), implant breakage (9, 31%), implant loosening (4, 13%), secondary arthrosis (2, 7%), leg shortening (2), infection (1, 3%), and 1 case of simultaneous cut-out and distal peri-implant fracture. The majority of cases requiring conversion (24, 82%) were seen in unstable fracture patterns A2.2 to A3.3. 4 patients (13%) were treated with DHS, 20 (69%) with a cephalomedulary nail, 1(3%) with an angled blade plate. 4 patients (13%) had at least two prior attempts of fixation. The mean time between fracture fixation and conversion to HA was 397 days. Unstable fracture patterns were not associated with an earlier loss of fixation. 28 were converted to THA and 1 case to HA. A cemented stem was used in 14(48%) cases vs uncemented in 15(52%). In 10 cases (34%) we used hardware for fracture fixation in addition to prosthesis implantation. We experienced complications in 10 patients (34%) of which 7(24%) required revision surgery. There were dislocations in 4 cases (13%), infection 2(7 %), persistent drainage 2, persistent pain due to fracture nonunion 1(3%), intraoperative periprosthetic fracture 1, and 1 case where the patient died in the early postop period. There was a sharp rise in incidence in 2017 from 1 to around 4 cases yearly and this has remained relatively stable since.
Despite advances in treatment salvage after fixation failure of pertrochanteric fractures remains a difficult pathology that continues to frustrate surgeons.
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