Conversion Total Hip Arthroplasty after Sliding Hip Screw and Cephalomedullary Nail Failures: A Systematic Comparative Review and Meta-analysis.

Abstract

With the exception of revision osteosynthesis, conversion total hip arthroplasty (CTHA) following sliding hip screw (SHS) and cephalomedullary nail (CMN) failure in intertrochanteric fractures (ITF) is the most commonly used treatment option. This review determined the relative risk of medical and orthopedic complications, including periprosthetic femoral fractures (PFF), following CTHA in failed SHS and CMN fixation of ITF, as well as the Harris hip score (HHS). Major electronic databases were searched for studies and reports on CTHA after SHS and CMN fixation failures in ITF. To assess the risk of bias, the studies were analyzed using the Joanna Briggs Institute critical appraisal tool for cohort studies. Three studies pooled 327 cases and 353 cases of CTHA from failed CMN and SHS in ITF. The relative risk of medical and orthopedic complications and PFF in the SHS group as compared to the CMN group was 0.87 [0.39, 1.90], 1.64 [1.18, 2.29], and 1.92 [0.81, 4.56], respectively. The mean difference in HHS was -0.72 [-1.47, 0.02] between failed SHS and CMN groups. The included studies were of retrospective study design with a more than 20% loss of follow-up and a high risk of bias. There is 64% more risk of orthopedic complications with CTHA in SHS failures than CMN failures. There is no difference in relative risk of medical complications and PFF between CTHA in both SHS and CMN failure. After CTHA, the benefits in function are similar in both groups.