Salvage total hip arthroplasty following hip fracture treatment-A systematic review and meta-analysis of the role of fracture type and implant design.

BACKGROUND

Salvage total hip arthroplasty (THA) has become an important procedure in managing failed hip fracture operations especially where primary internal fixation or hemiarthroplasty has failed. These surgeries are often complex and have a high risk of complications. The purpose of this study was to: (1) provide a comprehensive and critical analysis of cumulative complication rates for those undergoing salvage THA following failed hip fracture fixation; (2) Assess if there are any differences in complication risk based on (a) original fracture type; and (b) implant used for salvage arthroplasty.

METHODS

This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251018544). A comprehensive search of electronic databases (PubMed, CINAHL plus, EMBASE, and SCOPUS) was performed for all articles pertaining to this topic from 2004 to 2024. A total of 14 studies were found for inclusion in this systematic review.

RESULTS

Our study cohort consisted of 4968 salvage arthroplasties. Bias assessment found adequate representativeness of the cohort, ascertainment of exposure, and follow-up. The overall complication rate was 10% (n = 517) with all-cause revision rate being approximately 5% (n = 236). The most common complications were periprosthetic fractures (1.14%), dislocations (1.7%), deep infections (1.4%), and aseptic loosening (1.2%). Intertrochanteric fractures had a higher risk of periprosthetic fracture (14.9 versus 0%; p = 0.0001), dislocation (6.7 versus 1.3%; p = 0.001), deep infection (2.6 versus 1.2%), and aseptic loosening (5.2 versus 1%; p = 0.001). Metaphyseal stems, compared to diaphyseal, had a higher risk of aseptic loosening.

CONCLUSION

We found a high complication rate following salvage arthroplasty. However, these risks were much higher with failed intertrochanteric fracture fixation. Future studies should analyze comparisons related to the implants used for proximal femur fracture fixation and subsequent arthroplasty.