Comparison of Differences in Complications and Revision After Conversion to Total Hip Arthroplasty from Plating vs. Nailing vs. Hemiarthroplasty

Document Type : RESEARCH PAPER

Authors

1 University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, Texas

2 Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, Texas

Abstract

Background: Total hip arthroplasty (THA)after previous hip surgery increases the procedure complexity and complication rate. 
We investigated the complication rates following conversion to total hip arthroplasty from three hip surgeries, namely plate 
fixation of the intertrochanteric fracture, nailing of the trochanteric fracture, and hemiarthroplasty of the hip.
Methods: This retrospective study was conducted using the PearlDiver database (www.pearldiverinc.com, Colorado
Springs) and identified all patients undergoing THA between 2010 and 2019. Among this group, we included all patients 
who had received one of the three procedures , hip hemiarthroplasty (CPT 27125), fixation of the intertrochanteric fracture 
with plates and screws (CPT 27444), or fixation of hip fracture with nail (CPT 27445) within two years of THA. We analyzed 
complications in these patients and compared it to the complication rate in primary THA patients. The complications analyzed 
were 30-day transfusion risk, 90-day surgical site infection (SSI) risk, 90-day periprosthetic fracture risk, 1-year dislocation 
risk, and 2-, 5-, and 10-year revision risk. 
Results: A total of 118,209 patients underwent THA between 2010 and 2019. A total of 9,173, 48,326, and 31,632 patients 
underwent fixation with plates and screws , nailing and hemiarthroplasty respectively. We identified 71, 42, and 160 patients with 
hemiarthroplasty, plates & screws, and nailing, respectively, within two years of THA. 117,936 primary THA patients were used as 
a comparison group. The nailing group had the highest rate of transfusion risk (OR=2.34, 95% CI=1.32, 4.13, P<0.05).
Furthermore, the hemiarthroplasty group had highest rate of SSI risk (OR=9.25, 95% CI=4.86, 17.63, P<0.05) and highest 
revision risk at 2 years (OR=10.532, 95% CI= 6.09, 18.19, P<0.05).
Conclusion: Conversion of hemiarthroplasty to THA was associated with a higher risk of infection and revision. Hence, 
surgeons considering primary hip hemiarthroplasty for severely comminuted intertrochanteric fracture should exercise 
caution, especially for active elderly patients.
Level of evidence: III

Keywords


1. Douglas SJ, Remily EA, Sax OC, Pervaiz SS, Delanois 
RE, Johnson AJ. How Does Conversion Total Hip 
Arthroplasty Compare to Primary? J Arthroplasty 2021; 
36(7):S155-S159. doi: 10.1016/j.arth.2020.12.023.
2. Godoy-Monzon D, Diaz Dilernia F, Piccaluga F, Cid 
Casteulani A, Turus L, Buttaro M. Conversion total hip 
arthroplasty with a proximally modular, distal Fixation 
reconstruction prosthesis following cephalomedullar 
nail failure. Hip Int 2020; 30(1_suppl):26-33. doi: 
10.1177/1120700020937952.
3. Sarpong NO, Grosso MJ, Lakra A, Held MB, Herndon 
CL, Cooper HJ. Hemiarthroplasty Conversion: A 
Comparison to Primary and Revision Total Hip 
Arthroplasty. J Arthroplasty 2019; 34(6):1168-1173. 
doi: 10.1016/j.arth.2019.02.043. 
4. Hernandez NM, Fruth KM, Larson DR, Kremers HM, 
Sierra RJ. Conversion of Failed Hemiarthroplasty 
to Total Hip Arthroplasty Remains High Risk for 
Subsequent Complications. J Arthroplasty 2019; 
34(9):2030-2036. doi: 10.1016/j.arth.2019.04.042. 
5. Qin CD, Helfrich MM, Fitz DW, Oyer MA, Hardt 
KD, Manning DW. Differences in Post-Operative 
Outcome between Conversion and Primary Total Hip 
Arthroplasty. J Arthroplasty 2018; 33(5):1477-1480. 
doi: 10.1016/j.arth.2017.11.039. 
6. Sarpong NO, Grosso MJ, Lakra A,et al. Outcomes 
and survivorship after conversion of failed hip 
hemiarthroplasty to total hip arthroplasty. Hip Int 2021; 
31(3):388-392. doi: 10.1177/1120700019891427.
7. Schwarzkopf R, Chin G, Kim K, Murphy D, Chen AF. Do 
Conversion Total Hip Arthroplasty Yield Comparable 
Results to Primary Total Hip Arthroplasty? J 
Arthroplasty 2017; 32(3):862-871. doi: 10.1016/j.
arth.2016.08.036.
8. De Meo D, Ferraro D, Petriello L, et al. Outcome and 
technical consideration of conversion total hip 
arthroplasty after failed fixation of intracapsular 
and extracapsular hip fractures: Are they really that 
different? Injury 2020; 22:9040. doi: 10.1016/j.
injury.2020.09.045.
9. Sah AP, Estok DM. Dislocation rate after conversion 
from hip Hemiarthroplasty to total hip arthroplasty. J 
Bone Joint Surg Am 2008; 90(3):506-16. doi: 10.2106/
JBJS.G.00479.
10.Alazzawi S, Sprenger De Rover WB, Brown J, Davis 
B. The conversion rate of Bipolar hemiarthroplasty 
after a hip fracture to a total hip arthroplasty. Clin 
Orthop Surg 2012; 4(2):117-20. doi: 10.4055/
cios.2012.4.2.117.
11.Fichman SG, Mäkinen TJ, Vincent A, Lozano B, Safir 
O, Kuzyk PR. Complications following conversion of 
a hip hemiarthroplasty to a total hip Arthroplasty. Int 
Orthop 2015; 39(12):2335-9. doi: 10.1007/s00264-
015-2827-2.
12.Diwanji SR, Kim SK, Seon JK, Park SJ, Yoon TR. Clinical 
results of Conversion total hip arthroplasty after 
failed bipolar hemiarthroplasty. JArthroplasty 2008; 23(7):1009-15. doi: 10.1016/j.arth.2007.09.006.
13.Figved W, Dybvik E, Frihagen F, et al. Conversion 
from failed hemiarthroplasty to total hip 
arthroplasty: a Norwegian Arthroplasty Register 
analysis of 595 hips with previous femoral neck 
fractures. Acta Orthop 2007;78(6):711-8. doi: 
10.1080/17453670710014473.
14.Baghoolizadeh M, Schwarzkopf R. The Lawrence D. 
Dorr Surgical Techniques & Technologies Award: 
Conversion Total Hip Arthroplasty: Is it a Primary or 
Revision Hip Arthroplasty. J Arthroplasty 2016; 31(9 
Suppl):16-21. doi: 10.1016/j.arth.2015.06.024.
15.Smith A, Denehy K, Ong KL, Lau E, Hagan D, 
Malkani A. Total hip arthroplasty Following failed 
intertrochanteric hip fracture fixation treated with 
a cephalomedullary nail. Bone Joint J 2019; 101-B 
(6_Supple_B):91-96. doi: 10.1302/0301-620X.101B6.
BJJ-2018-1375.R1.
16.Yuan BJ, Abdel MP, Cross WW, Berry DJ. Hip Arthroplasty 
After Surgical Treatment of Intertrochanteric Hip 
Fractures. J Arthroplasty 2017; 32(11):3438-3444. 
doi: 10.1016/j.arth.2017.06.032.
17.Exaltacion JJ, Incavo SJ, Mathews V, Parsley B, 
Noble P. Hip arthroplasty After intramedullary 
hip screw fixation: a perioperative evaluation. J 
Orthop Trauma 2012; 26(3):141-7. doi: 10.1097/
BOT.0b013e318221ea6b.
18.Zeng X, Zhan K, Zhang L, et al. Conversion to total 
hip arthroplasty after failed proximal femoral nail 
antirotations or dynamic hip screw fixations for stable 
intertrochanteric femur fractures: a retrospective 
study with a minimum follow-up of 3 years. BMC 
Musculoskelet Disord. 2017; 18(1):38. doi: 10.1186/
s12891-017-1415-6.
19.Yu W, Han X, Chen W, et al. Conversion from a failed 
proximal femoral nail anti-rotation to a cemented 
or uncemented total hip arthroplasty device: a 
retrospective review of 198 hips with previous 
intertrochanteric femur fractures. BMC Musculoskelet 
Disord 2020; 21(1):791. doi: 10.1186/s12891-020-
03806-0. 
20.Parker MJ, Handoll HH. Replacement arthroplasty 
versus internal fixation for extracapsular hip 
fractures in adults. Cochrane Database Syst Rev 
2006: 2006(2):CD000086. doi: 10.1002/14651858.
CD000086.pub2.
21.Newman JM, Webb MR, Klika AK, Murray TG, Barsoum 
WK, Higuera CA. Quantifying Blood Loss and 
Transfusion Risk after Primary vs Conversion Total 
Hip Arthroplasty. J Arthroplasty 2017; 32(6):1902-
1909. doi: 10.1016/j.arth.2017.01.038.
22.Pankaj A, Malhotra R, Bhan S. Conversion of failed 
hemiarthroplasty to total hip arthroplasty: a short 
to mid-term follow-up study. Indian J Orthop 
2008;42(3):294-300. doi: 10.4103/0019-5413.41852.
23.Park KS, Chan CK, Lee DH, Yoon TR. Midterm Results 
of Conversion from Failed Bipolar Hemiarthroplasty to Total Hip Arthroplasty. Indian J Orthop 2018; 
52(4):369 373. doi: 10.4103/ortho.IJOrtho_494_16.
24.Ryan SP, DiLallo M, Attarian DE, Jiranek WA, Seyler 
TM. Conversion vs Primary Total Hip Arthroplasty: 
Increased Cost of Care and Perioperative 
Complications. J Arthroplasty 2018; 33(8):2405-2411. 
doi: 10.1016/j.arth.2018.03.006.
25.Morice A, Ducellier F, Bizot P. Total hip arthroplasty after 
failed fixation of a proximal femur fracture: Analysis of 
59 cases of intra- and extra-capsular fractures. Orthop 
Traumatol Surg Res 2018; 104(5):681-686. doi: 
10.1016/j.otsr.2018.04.015. 
26.Dix DB, Araoye IB, Staggers JR, et al. A systematic review 
and meta-analysis of complications in conversion 
arthroplasty methods for failed intertrochanteric 
fracture fixation. J Clin Orthop Trauma 2019; 
10(2):282-285. doi: 10.1016/j.jcot.2018.02.007.