A systematic review and meta-analysis of complications in conversion arthroplasty methods for failed intertrochanteric fracture fixation

Abstract

Conversion arthroplasty for failed primary fixation of intertrochanteric fractures can be achieved using various methods, including cemented total hip arthroplasty, uncemented total hip arthroplasty, hybrid total hip arthroplasty, and hemiarthroplasty. Complication rates vary between each conversion method. The purpose of this paper is to examine the effect of conversion method on total conversion complication rates. We performed a meta-analysis of five studies with sufficient data for analysis. We created a null hypothesis stating that the expected distribution of complications across conversion methods would reflect the distribution of conversion method used for failed primary fixation. Using a z test, we compared proportions of the expected distribution of complications to the observed distribution of complications. A total of 138 cases of conversion arthroplasty with 49 complications were available for analysis. The mean age was 73 (range, 32–96) years. 19 males and 48 females were included, with one study not including patient gender. The mean time from primary fixation failure to conversion was 11 months, and the mean duration of conversion surgery was 132 min. Expected and observed complication rate distributions were as follows: cemented total hip arthroplasty, 6.5% versus 4.1% ( p  = 0.79); uncemented total hip arthroplasty, 77.5% versus 81.6% ( p  = 0.69); hybrid total hip arthroplasty, 2.9% versus 2.0% ( p  = 1); and hemiarthroplasty, 13% versus 12.2% ( p  = 1). Our findings suggest that the method of conversion arthroplasty following failed primary intertrochanteric femur fracture fixation does not influence complication rate.