Total Hip Arthroplasty for Proximal Femoral Nonunion and Malunion
Nonunions and malunions may complicate the treatment of proximal femur fractures. These sequelae often occur in the setting of poor bone stock or a compromised host, thereby adding to the complexity of their presentation. Hip arthroplasty after failed fracture treatment (often referred to as “conversion arthroplasty”) can often be employed as a salvage procedure in these difficult clinical scenarios to improve pain and limitations in mobility. However, previously placed hardware may alter patient anatomy, create potential stress risers, and confer a higher risk for postoperative complications including infection and instability. These surgeries often require revision components and adjunctive techniques including trochanteric osteotomies or bone grafting. This chapter will outline the indications for conversion arthroplasty in the setting of proximal femoral nonunions and malunions, discuss technical pearls and pitfalls of these surgical interventions, and present their reported clinical outcomes.
KeywordsHip Hip fractures Nonunion Malunion Total hip arthroplasty Hemiarthroplasty Conversion arthroplasty Fragility fractures Osteoporosis Trochanteric osteotomy Bone grafting Salvage arthroplasty
- 5.Strömqvist B, Hansson LI, Nilsson LT, Thorngren KG. Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases. Clin Orthop Relat Res. 1987;218:58–62.Google Scholar
- 15.Caruso G, Bonomo M, Valpiani G, Salvatori G, Gildone A, Lorusso V, et al. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: can the tip-apex distance (TAD) still be considered the best parameter? Bone Joint Res. 2017;6(8):481–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Qin CD, Helfrich MM, Fitz DW, Oyer MA, Hardt KD, Manning DW. Differences in post-operative outcome between conversion and primary total hip arthroplasty. J Arthroplast. 2017:1477–80.Google Scholar
- 18.McLawhorn AS, Schairer WW, Schwarzkopf R, Halsey DA, Iorio R, Padgett DE. Alternative payment models should risk-adjust for conversion total hip arthroplasty: a propensity score-matched study. J Arthroplast. 2017:2025–30.Google Scholar
- 23.Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89(2):160–5.CrossRefPubMedGoogle Scholar