Document Type : RESEARCH PAPER
Orthopedic Surgeon, Department of Orthopaedic Surgery, University of Texas southwestern Texas, USA.
University of Texas southwestern, Dallas, Texas
Background: In this study we identified the complication rate following conversion total hip done for three commonly performed hips surgeries namely Plate fixation of Intertrochanteric fracture, Nailing of the trochanteric fracture and hemiarthroplasty of the hip.
Methods: In this retrospective study, we used the PearlDiver patient record database( www.pearldiverinc.com, Colorado Springs, CO, USA). We used the Humana subset (MSOrtho30) of the database and included all patients between 2010 and 2019. All patients undergoing THR within 2 years after hip hemiarthroplasty (CPT 27135), Fixation of IT fracture with plates and screws (CPT 27444) and fixation of hip fracture with nail (CPT 27445) included. We analyzed the risk of various complications in the first two years and compared to primary THR patient. The complications analyzed includes 30 day transfusion risk, 90 days SSI risk, 90 days periprosthetic fracture risk, 1 year dislocation risk and 2 years/5 years/10years revision risk.
Results: We identified 118 209 patients who underwent total hip arthroplasty between 2010 and 2019 in the database. We identified 9173 patients undergoing fixation with plates and screws (CPT- 27244), 48,326 members undergoing nailing (CPT- 27245) and 31632 patients undergoing hemiarthroplasty (CPT -27125). We identified 71 patients who underwent hemiarthroplasty within before 2 years of their total hip arthroplasty, we identified 42 patient who had plates and screws before their total hip arthroplasty and 160 patients who had nailing 2 years before their total hip arthroplasty. Excluding the patients undergoing these three procedures we created a cohort of 117 939 total hip arthroplasty patients for comparison group.
Transfusion risk was highest in the Nailing group OR- 2.34 (1.32 to 4.13)
P<0.05.Surgical site infection risk was highest in the Hemiarthroplasty group OR- 9.25 (4.86 to 17.63) p<0.05.Revision risk was highest in the hemiarthroplasty at 2 years [OR-10.532 (6.09 to 18.19) P<0.05], 5 years [OR-9.479 (5.54 to 16.21) P<0.05] and 10 years [OR- 9.07 (5.3 to 15.52) P<0.05]
Conclusion: Conversion of hemiarthroplasty to Total hip is associated with higher risk of infection and revision compared to conversion of nailing or plating to total hip replacement. Hence surgeon considering primary hemiarthroplasty for severely comminuted