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

Document Type : RESEARCH PAPER


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

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


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 (, 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


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