Journal article
Total hip arthroplasty following failed intertrochanteric hip fracture fixation treated with a cephalomedullary nail
The bone & joint journal, v 101-B(6_Supple_B), pp 91-96
Jun 2019
PMID: 31146562
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN.
Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an intertrochanteric fracture that was treated using a CMN during the previous five years was identified and compared with the remaining patients who underwent THA. The length of stay (LOS) was compared using both univariate and multivariate analysis. The incidence of infection, dislocation, revision, and re-admission was compared between the two groups, using multivariate analysis adjusted for demographic, hospital, and clinical factors.
The Medicare data yielded 56 522 patients who underwent primary THA, of whom 369 had previously been treated with a CMN. The percentage of THAs that were undertaken between 2002 and 2005 in patients who had previously been treated with a CMN (0.346%) more than doubled between 2012 and 2015 (0.781%). The CMN group tended to be older and female, and to have a higher Charlson Comorbidity Index and lower socioeconomic status. The mean LOS was 1.5 days longer (5.3
3.8) in the CMN group (p < 0.0001). The incidence of complications was significantly higher in the CMN group compared with the non-CMN group: infection (6.2%
2.6%), dislocation (8.1%
4.5%), revision (8.4%
4.3%), revision for infection (1.1%
0.37%), and revision for dislocation (2.2%
0.6%).
The incidence of conversion to THA following failed intertrochanteric hip fracture fixation using a CMN continues to increase. This occurs in elderly patients with increased comorbidities. There is a significantly increased risk of infection, dislocation, and LOS in these patients. Patients with failed intertrochanteric hip fracture fixation using a CMN who require THA should be made aware of the increased risk of complications, and steps need to be taken to reduce this risk. Cite this article:
2019;101-B(6 Supple B):91-96.
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Details
- Title
- Total hip arthroplasty following failed intertrochanteric hip fracture fixation treated with a cephalomedullary nail
- Creators
- A Smith - University of LouisvilleK Denehy - University of LouisvilleK L Ong - Exponent (United States)E Lau - ExponentD Hagan - University of LouisvilleA Malkani - University of Louisville
- Publication Details
- The bone & joint journal, v 101-B(6_Supple_B), pp 91-96
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- School of Biomedical Engineering, Science, and Health Systems
- Web of Science ID
- WOS:000469965700015
- Scopus ID
- 2-s2.0-85067306664
- Other Identifier
- 991019170852204721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- Web of Science research areas
- Orthopedics
- Surgery