JOA - 2026-04-24 - Journal Article
Total Hip Arthroplasty Following Failed Cephalo-medullary Nailing: An Analysis of Outcomes and Complications Associated with Failures.
Garvin KL, Zitsch B, Bernal AS, Gribben P, Xiong W, Danielson PW
Topics
Key Takeaway
Conversion THA after failed cephalomedullary nailing carries a 3x higher medical complication rate (33% vs 11.1%, P=0.032) and nearly 3x greater intraoperative blood loss (803.8 vs 282.1 mL, P<0.0001) compared to primary THA for osteoarthritis.
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Summary
This study compared perioperative outcomes and complications between conversion THA after failed CMN and matched primary THA for osteoarthritis in patients aged 50–75. Conversion THA demonstrated equivalent surgical complication rates but significantly higher medical complication rates (33% vs 11.1%) and greater blood loss (803.8 vs 282.1 mL). Gluteus medius tendon disruption from CMN placement averaged 20.8% of total insertion area (range 13.08–37.10%), with implications for postoperative abductor function.
Key Limitation
Functional outcome data (HOOS Jr. scores) are not reported with actual values or between-group comparisons despite being a stated primary outcome, leaving the functional impact of gluteus medius disruption unquantified.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) is a highly successful operation for patients who have primary osteoarthritis and for those requiring conversion for traumatic arthritis. This study aimed to compare the clinical outcomes, complication rates, and overall functional results between THA performed after failed cephalo-medullary nailing (CMN) for hip fractures and primary THA for osteoarthritis.
METHODS
A retrospective review was conducted on 81 patients, aged 50 to 75 years, who underwent THA. Patients receiving primary THA for osteoarthritis were matched in a 2:1 ratio with those undergoing conversion THA following failed CMN. Matching criteria included age, sex, body mass index (BMI), and comorbidity profile. Outcomes assessed included surgical and medical complications and functional performance based on the Hip disability and Osteoarthritic Outcome Score, Junior version (HOOS Jr.). The area of the gluteus medius muscle insertion on the greater trochanter was measured to determine the cross-sectional area disrupted during CMN placement. Comparative analyses utilized Chi-square tests for categorical variables and Student's t-tests for continuous variables.
RESULTS
There was no significant difference in surgical complication rates between the two groups. However, the overall medical complication rate was higher in the conversion THA compared to the primary THA (33 versus 11.1%, P = 0.032). Blood loss during the procedure was significantly more in the conversion THA compared to primary THA (282.1 ± 130.9 versus 803.8 ± 603.3 ml, P < 0.0001). The proportion of gluteus medius tendon disruption, normalized to total insertion area, ranged from 13.08 to 37.10%, with a mean of 20.8%.
CONCLUSION
Conversion THA following failed CMN is associated with significantly higher perioperative medical complications and greater blood loss compared with primary THA. The abductor tendon damage, particularly the gluteus medius tendon disruption, was incurred during initial CMN fixation, which may adversely affect postoperative recovery and functional outcomes.