Di Martino Alberto, D'Agostino Claudio, Poluzzi Riccardo, Brunello Matteo, Geraci Giuseppe, Traina Francesco, Faldini Cesare
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
1st Orthopedic and Traumatology Department, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy.
Eur J Trauma Emerg Surg. 2025 Sep 16;51(1):293. doi: 10.1007/s00068-025-02977-6.
The goal of this systematic review is to analyse clinical results and complications of conversion total hip arthroplasty (cTHA) after failure of internal fixation (IFix), distinguishing according to the initial fixation method: intramedullary nail, plate/screw systems, and cannulated screws.
PubMed, EMBASE, and Cochrane database were firstly accessed in April 2025, and lastly checked on July 2025, to identify studies addressing patients who underwent to cTHA after sustaining proximal femoral fractures with subsequent IFix. The PRISMA guidelines were followed, and the quality of studies was assessed. Data were extracted from the identified articles and summarised.
Twelve retrospective studies on 1,260 patients analyzed complications of conversion to total hip arthroplasty (cTHA) after internal fixation of the femur. After fixation with an intramedullary nail, cTHA showed a 6.01% dislocation rate, 3.14% periprosthetic fractures, 2.59% aseptic loosening, and 3.41% periprosthetic infections, with a 3.82% reoperation rate. Fixation with a plate/screw system resulted in fewer complications but a higher incidence of periprosthetic fractures (11.57%). A notably higher dislocation rate of 10.04% was observed following fixation with cannulated screws.
This review confirms that cTHA after IFix of proximal femoral fractures is associated to an elevated rate of perioperative complications, with a higher incidence when cTHA is performed after intramedullary nail fixation; a higher incidence of intraoperative periprosthetic fractures is observed on those patients treated by plate/screws system at first surgery. Unexpectedly, a higher rate of implant dislocations is recorded in those patients undergoing cTHAs after IFix by cannulated screws.
本系统评价的目的是分析内固定失败后全髋关节置换术（cTHA）的临床结果和并发症，根据初始固定方法进行区分：髓内钉、钢板/螺钉系统和空心螺钉。
于2025年4月首次检索PubMed、EMBASE和Cochrane数据库，并于2025年7月进行最后一次检索，以识别涉及股骨近端骨折后接受内固定治疗并随后接受cTHA的患者的研究。遵循PRISMA指南，并评估研究质量。从已识别的文章中提取数据并进行总结。
12项针对1260例患者的回顾性研究分析了股骨内固定后全髋关节置换术（cTHA）的并发症。使用髓内钉固定后，cTHA的脱位率为6.01%，假体周围骨折率为3.14%，无菌性松动率为2.59%，假体周围感染率为3.41%，再次手术率为3.82%。使用钢板/螺钉系统固定导致的并发症较少，但假体周围骨折的发生率较高（11.57%）。使用空心螺钉固定后观察到脱位率显著更高，为10.04%。
本综述证实，股骨近端骨折内固定后行cTHA与围手术期并发症发生率升高相关，髓内钉固定后行cTHA时发生率更高；首次手术采用钢板/螺钉系统治疗的患者术中假体周围骨折发生率更高。出乎意料的是，空心螺钉内固定后行cTHA的患者植入物脱位率更高。
