BACKGROUND: Although use of intramedullary hip screws (IMHS) for intertrochanteric (IT) hip fractures has become more common, limited data have suggested difficulties in conversion to hip arthroplasty. The present study investigates whether conversion of failed IT fracture fixation with an intramedullary vs extramedullary device leads to different rates or types of complications or decreased arthroplasty survivorship. METHODS: One hundred eleven patients were converted to hip arthroplasty after previous surgical treatment of an IT fracture from 2000 to 2010. Seventy hips had been treated with an extramedullary fixation device (EFD) and 41 with an IMHS. RESULTS: Length of hospital stay and operative times were similar (6 days and 206 minutes for EFD vs 6 days and 208 minutes for IMHS; P > .7). The presence of a Trendelenburg gait at last clinical follow-up was similar between groups (37% in EFD group and 38% in IMHS group). Five-year survivorship free of revision was 95% in the EFD group and 94% in the IMHS group (P = 1.0). The overall complication rate was similar (21% for EFD vs 27% for IMHS; P = .51) between groups. The most common complication was late periprosthetic fracture in the EFD patients (6% vs 0% in IMHS; P = .29) and intraoperative femoral fracture in the IMHS patients (12% vs 1% in EFD; P = .02). CONCLUSION: The short-term survivorship of conversion hip arthroplasty after surgical treatment of an IT fracture is excellent regardless of original fracture fixation method. If early complications, particularly periprosthetic fractures, can be minimized, the likelihood of a successful outcome is high. The risk of intraoperative femoral fracture was greater during conversion from an IMHS compared to an EFD.
BACKGROUND: Although use of intramedullary hip screws (IMHS) for intertrochanteric (IT) hip fractures has become more common, limited data have suggested difficulties in conversion to hip arthroplasty. The present study investigates whether conversion of failed IT fracture fixation with an intramedullary vs extramedullary device leads to different rates or types of complications or decreased arthroplasty survivorship. METHODS: One hundred eleven patients were converted to hip arthroplasty after previous surgical treatment of an IT fracture from 2000 to 2010. Seventy hips had been treated with an extramedullary fixation device (EFD) and 41 with an IMHS. RESULTS: Length of hospital stay and operative times were similar (6 days and 206 minutes for EFD vs 6 days and 208 minutes for IMHS; P > .7). The presence of a Trendelenburg gait at last clinical follow-up was similar between groups (37% in EFD group and 38% in IMHS group). Five-year survivorship free of revision was 95% in the EFD group and 94% in the IMHS group (P = 1.0). The overall complication rate was similar (21% for EFD vs 27% for IMHS; P = .51) between groups. The most common complication was late periprosthetic fracture in the EFD patients (6% vs 0% in IMHS; P = .29) and intraoperative femoral fracture in the IMHSpatients (12% vs 1% in EFD; P = .02). CONCLUSION: The short-term survivorship of conversion hip arthroplasty after surgical treatment of an IT fracture is excellent regardless of original fracture fixation method. If early complications, particularly periprosthetic fractures, can be minimized, the likelihood of a successful outcome is high. The risk of intraoperative femoral fracture was greater during conversion from an IMHS compared to an EFD.
Authors: James M Rizkalla; Brian P Gladnick; Aamir A Bhimani; Dorian S Wood; Kurt J Kitziger; Paul C Peters Journal: Curr Rev Musculoskelet Med Date: 2020-08