Impact of fracture reduction quality on clinical outcomes in hip arthroplasty for intertrochanteric fractures based on a novel radiographic evaluation system: a retrospective study.

BACKGROUND

The impact of fracture reduction quality on clinical outcomes in hip arthroplasty for intertrochanteric fractures remains insufficiently characterized. This study aimed to establish a standardized postoperative radiographic evaluation system for reduction quality and assess its correlation with postoperative function and complications.

METHODS

A retrospective cohort study included 237 patients undergoing hip arthroplasty for intertrochanteric fractures (2012-2024). Reduction quality was classified as optimal, acceptable, or poor based on four criteria: (1) greater trochanter alignment, (2) lesser trochanter reduction, (3) femoral stem stability, and (4) postoperative femoral anteversion (optimal: 13 ± 3°; acceptable: 6-10° or 16-20°; poor: <6° or >20°). Outcomes included Harris Hip Scores, Engh's scores, delayed healing, and complications. Statistical analyses were adjusted for AO/OTA fracture classification.

RESULTS

Optimal reduction (Grade A, n = 107) correlated with superior Harris Hip Scores (92.57 ± 4.27 vs. 82.46 ± 7.05, P < 0.001), lower delayed healing (3.74% vs. 14.29%, P = 0.031), and reduced abductor weakness (1.87% vs. 14.29%, P = 0.014). Acceptable reductions (Grade B, n = 74) showed intermediate outcomes. Poor reductions (Grade C, n = 56) exhibited the highest complication rates. Engh's scores were significantly higher in Grade A (97.20% vs. 73.21%, P = 0.002). Dislocation and heterotopic ossification rates did not differ significantly (P > 0.05).

CONCLUSION

This study introduced and validated a standardized radiographic evaluation system to assess reduction quality in arthroplasty for intertrochanteric fractures, emphasizing the prognostic importance of anatomic trochanteric alignment and cortical continuity. High-quality reduction is critical for optimizing functional recovery and minimizing complications in arthroplasty for intertrochanteric fractures. Future research should explore long-term outcomes and advanced fixation techniques to enhance reduction precision.