Outcome of hemiarthroplasty to total hip arthroplasty conversion: a systematic review.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics approval: The institutional ethics committee approved the study (AIIMS/IEC/22/267). Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The study was conducted in All India Institute of Medical Sciences, Rishikesh, India. Consent to participate: Informed consent was obtained from all individual participants included in the study. 9. Medicina (Kaunas). 2021 Jul 27;57(8):763. doi: 10.3390/medicina57080763. Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes. Martinho T(1)(2), Stoffel K(3). Author information: (1)Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany. (2)Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. (3)Department of Orthopaedics and Traumatology, University of Basel, Petersgraben 4, 4031 Basel, Switzerland. Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon's preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique. DOI: 10.3390/medicina57080763 PMCID: PMC8400749