The impact of conversion arthroplasty for failed femoral neck or intertrochanteric fractures on complication and mortality rates: A "second-hit" effect?

BACKGROUND

Data on the risk of morbidity and mortality following conversion arthroplasty for fixation failure of femoral neck fractures (FNFs) or intertrochanteric fractures (ITFs) remains limited. This study compares medical outcomes between: (1) initial fixation and conversion arthroplasty for failed FNFs and ITFs, and (2) conversion arthroplasty for failed FNFs vs failed ITFs.

METHODS

A retrospective review of an institutional database at Taipei Veterans General Hospital identified patients who underwent conversion arthroplasty for failed internal fixation of FNFs or ITFs from January 2010 to December 2022. Primary outcomes included frequencies of in-hospital complications, 90-day readmissions following initial fixation and conversion arthroplasty, and 90-day and 1-year mortality after conversion arthroplasty. To compare outcomes for conversion arthroplasty between failed FNFs and ITFs, cohorts were matched by age, body mass index, and age-adjusted Charlson Comorbidity Index.

RESULTS

A total of 70 patients with failed FNFs and 66 patients with failed ITFs were included. The in-hospital complication frequency was higher following conversion arthroplasty (FNF: 44.3% vs 17.1%, p < 0.001; ITF: 54.5% vs 31.8%, p = 0.008) compared with initial fixation. Although conversion arthroplasty for failed ITFs involved a longer procedure time (125.5 ± 46.2 vs 86.8 ± 31.1 minutes, p < 0.001), greater estimated blood loss (1088.1 ± 603.8 vs 513.1 ± 287.7 mL, p < 0.001), and higher transfusion rate (81.0% vs 31.7%, p < 0.001) and volume (2.6 ± 2.0 vs 0.8 ± 1.2 units, p < 0.001) compared with failed FNFs, the in-hospital complication, readmission, and mortality rates were similar between the two groups.

CONCLUSION

Conversion arthroplasty for failed FNFs and ITFs was associated with worse medical outcomes, including a higher rate of in-hospital complications, compared with initial fixation. Despite greater surgical complexity associated with conversion arthroplasty for failed ITFs compared with failed FNFs, the in-hospital complication, readmission, and mortality rates were similar.