Conversion Total Hip Arthroplasty After Intramedullary Nailing: Outcomes Based on Surgical Approach

Abstract

Background: The incidence of conversion total hip arthroplasty (cTHA) following femoral intramedullary nail (IMN) fracture fixation is increasing. However, little is known about the effect surgical approach has on patient outcomes. The purpose of this study was to compare outcomes of cTHA after IMN between direct anterior (DAA) or postero-lateral (PLA) approach conversions.

Methods: We retrospectively reviewed our institutional cases of cTHA after IMN from November 2009 to August 2023. Demographics, operative data, implant information, and postoperative outcomes were collected. Outcomes following DAA or PLA conversion were then compared. We identified 60 patients who had cTHA after IMN by 10 traumatology or adult reconstruction fellowship-trained orthopaedic surgeons (24 DAA, 36 PLA). The mean time from IMN to cTHA was 7.6 years. Mean follow-up after cTHA was 2.1 years. The most common indication for cTHA was post-traumatic osteoarthritis.

Results: The PLA group had higher estimated blood loss (P < 0.05). There were no statistically significant differences in demographics, surgical time, transfusion rate, length of stay, discharge disposition, superficial or deep infection, periprosthetic fractures, dislocations, all-cause revisions, or 90-day readmission, reoperation, emergency department visit, or mortality rates.

Conclusions: Our institutional experience does not suggest superiority of either the DAA or PLA for improving outcomes in cTHA after IMN. Awareness of approach-specific surgical considerations and complications, combined with surgeon comfort and experience, should guide individualized case preparation and patient counseling.

Level of evidence: Therapeutic study, Level III (retrospective cohort study).

Keywords: conversion total hip arthroplasty; direct anterior approach; femoral intramedullary nail; post-traumatic osteoarthritis; postero-lateral approach.