Complication Analysis of Conversion Hip Arthroplasty after Failed Intertrochanteric Fracture Fixation: A Meta-Analysis

Abstract

Background: Although internal fixation (IF) techniques for intertrochanteric fractures have continuously advanced, the failure rate remains around 5%, often requiring secondary surgical intervention. This meta-analysis aimed to evaluate the clinical outcomes of conversion hip arthroplasty (CHA) following IF failure in intertrochanteric fracture patients. Methods: A total of 1,468 hips with CHA for failed IF of intertrochanteric fracture from 25 studies were included. The primary outcome was complication rate, including loosening, infection, dislocation, and periprosthetic fractures. The secondary outcomes were functional outcome measured by Harris Hip Score (HHS), operation time, and perioperative blood loss. A proportion metaanalysis using a random-effects model was performed to estimate the complications. Results: The mean follow-up period of the included studies was 51.08 months. The overall complication rate was 17%. Among specific complications, the loosening and infection rates were both 3%, while the dislocation rate was 5%. The pooled incidence of periprosthetic fractures including intraoperative and postoperative fractures was 9%. The mean HHS was 84.19. The mean operation time was 150.24 minutes, and the mean perioperative blood loss was 918.39 mL. Conclusions: CHA demonstrates an overall complication rate of 17%, which is slightly higher than that of primary hip arthroplasty, mainly reflecting the elevated risks of periprosthetic fractures and dislocation. Despite these concerns, CHA yields favorable functional recovery and represents an effective salvage strategy following failed IF, thereby supporting its continued role in clinical practice.