Functional outcome of conversion total hip arthroplasty (CTHA) using uncemented distally loading femoral stem for failed fixation of proximal femoral nail - A case series

Mathur, Hemant H; Shah, Harsh; Vishwanathan, Karthik

doi:10.1016/j.jor.2022.07.014

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…Conversion to cemented THA is a complicated and laborious process, particularly in geriatric individuals who rely heavily on rapid recovery of early mobilization with full weight-bearing to combat a range of immobilization-related complications [ 1 , 8 , 27 , 28 ]. However, cemented conversion may be associated with the femoral component loosening attributed to the combined axial loads and rotational moments [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…3 The variation trend of functional outcomes following conversion to cemented THA Fig. 4 Kaplan-Meier survivorship with a functioning score of less than 72 as the endpoint immobilization-related complications [1,8,27,28]. However, cemented conversion may be associated with the femoral component loosening attributed to the combined axial loads and rotational moments [29].…”

Section: Discussionmentioning

confidence: 99%

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Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years

Zhang

et al. 2022

BMC Musculoskelet Disord

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Background Given the ever-increasing rate of failure related to proximal femoral nail antirotation (PFNA), it is expected that an increasing number of PFNA individuals will undergo conversion to total hip arthroplasty (THA). The long-term survivorship of conversion of the initial PFNA to cemented THA is still debated. The aim of this retrospective study was to assess the long-term revision-free survivorship of cemented THAs after initial failures of PFNA in geriatric individuals. Methods Consecutive geriatric individuals who underwent secondary cemented THA after initial PFNA fixation from July 2005 to July 2018, were retrospectively identified from three medical centres. The primary outcome was revision-free survivorship estimated using the Kaplan–Meier method and Cox proportional hazards regression with revision for any reason as the endpoint; secondary outcomes were functional outcomes and key THA-related complications. Follow-ups occurred at 3 months, 6 months, 12 months and then every 12 months after conversion. Results In total, 186 consecutive patients (186 hips) were available for study inclusion. The median follow-up was 120.7 months (60–180 months) in the cohort. Kaplan–Meier survivorship with revision for any reason as the end point showed that the 10-year revision-free survival rate was 0.852 (95% confidence interval [CI], 0.771–0.890). Good functional outcomes were seen, and the HHS decreased markedly over the 24th month to the final follow-up interval from 92.2 to 75.1 (each p < 0.05). The overall rate of key THA-related complications was 16.1% (30/186). Conclusion Cemented THA executed following initial PFNA failure may yield satisfactory revision-free survival and, at least for the initial 10 years after conversion, good functional outcomes and a 16.1% complication rate of key THA-related complications, which supports the trend towards increased use of cemented THA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years

Zhang

et al. 2022

BMC Musculoskelet Disord

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Primary stability of multi-hole acetabular cup combined with posterior column plating for the fixation of complex acetabular fractures in elderly patients: a biomechanical analysis

Yan,

Wang,

Cui

et al. 2024

Arch Orthop Trauma Surg

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Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection

Huang,

Ding

et al. 2024

Orthopaedic Surgery

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PurposeFollowing failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes.MethodsOur retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components.ResultsThe study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402).ConclusionThe selection of femoral prostheses following FIF‐ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long‐stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.

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Functional outcome of conversion total hip arthroplasty (CTHA) using uncemented distally loading femoral stem for failed fixation of proximal femoral nail - A case series

Cited by 3 publications

References 37 publications

Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years

Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years

Primary stability of multi-hole acetabular cup combined with posterior column plating for the fixation of complex acetabular fractures in elderly patients: a biomechanical analysis

Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection

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