Comparative Outcomes of Early Versus Late Conversion to Total Hip Arthroplasty Following Hip Fracture Fixation

Background: Hip fractures are prevalent orthopaedic injuries with substantial morbidity and mortality. Failed primary treatments of these fractures often necessitate conversion to total hip arthroplasty (CTHA); a complex procedure requiring extensive exposure and hardware removal. It poses major challenges and is associated with high rates of complications such as infection, dislocation, and periprosthetic fractures. Despite the documented risks, there is limited data comparing complication rates between early (within one year) and late (after one year) CTHA. This study aimed to compare early and late CTHA and hypothesized that early CTHA was associated with higher complication rates than late CTHA.

Methods: A retrospective cohort study was conducted using an administrative claims database. The time from primary fixation of the proximal femur fracture to CTHA was used to identify patients who underwent early (n = 1,205) and late (n = 6,455) CTHA. Rates of joint complications within two years and medical complications within 90 days postoperatively were compared using multivariable logistic regressions.

Results: Early CTHA patients exhibited significantly higher rates of reoperation (8.3 versus 5.1%; OR [odds ratio]: 1.72), periprosthetic infections (7.1 versus 5.2%; OR: 1.50), periprosthetic fractures (5.4 versus 2.6%; OR: 1.73), mechanical complications (5.2 versus 3.1%; OR: 1.60), and dislocations (7.7 versus 3.9%; OR: 1.97). Overall, 19.4% of early conversion patients experience an orthopaedic complication, compared to 12.4% of late conversions. Medical complications within 90 days included higher rates of DVT in early CTHA patients (1.7 versus 0.8%; OR: 1.99), transfusions (5.6 versus 3.1%; OR: 1.50), and hospital readmission (13.9 versus 9.3%; OR: 1.39).

Conclusion: Early CTHA was associated with higher rates of complications compared to late conversion. Understanding these risks allows surgeons to better prepare patients for the surgery and ensure that patients have a realistic understanding of their prognosis and are adequately prepared for the challenges of recovery.