Retrospective Review of Outcomes of Conversion Total Hip Arthroplasty Following Failed Internal Fixation at Mean 3.1-Year Follow-Up.

Abstract

Conversion total hip arthroplasty (THA) following failed open reduction and internal fixation (ORIF) of a hip fracture is a challenging and complex procedure. While outcomes and surgical considerations of primary and revision THA are well-reported in the literature, conversion THA remains far less studied. This study evaluates the three- to five-year survivorship and clinical outcomes of conversion THA following failed ORIF to treat a hip fracture. A total of 47 patients who underwent conversion hip arthroplasty between January 1, 2011, and December 31, 2024, were identified for our retrospective review. Of these, 42 patients underwent conversion THA, and five underwent conversion bipolar hemiarthroplasty. Overall, 31 of 47 (66.0%) were women, the mean age at surgery was 66 years (range, 16 to 101), and the mean follow-up was 3.1 years (range, 0.25 to 16). Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery for any reason. Kaplan-Meier survivorship for patients who underwent conversion hip arthroplasty due to all-cause failure was 88.2% at one, three, and five years (95% CI [confidence interval] 98.6 to 78.9) with 29, 14, and six hips at risk, respectively. The overall complication rate was 21.3%, with infection being the most prevalent (10.6%). The overall reoperation rate was 10.6%. Reasons for revision included infection (6.4%), dislocation (2.1%), and abductor insufficiency (2.1%). Harris hip scores significantly increased from 47.5 (standard deviation (SD) 18.15) preoperatively to 83.3 (SD 9.64) at final postoperative follow-up (P < 0.001). All patients (100.0%) were ambulatory at follow-up. Of these, 59.3% demonstrated normal gait, 18.5% antalgic gait, and 22.2% Trendelenburg gait postoperatively. Conversion THA to treat failed ORIF of a hip fracture provides acceptable three- to five-year survivorship and clinical outcomes. Future studies should investigate larger patient cohorts and patient-reported outcomes across a longer follow-up period.