The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study
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European Journal of Medical Research Open Access
RESEARCH
The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study Soufiane Aharram1,2* , Mounir Yahyaoui1,2, Jawad Amghar1,2, Abdelkarim Daoudi1,2 and Omar Agoumi1,2
Abstract Background and study aims: The success of conversion total hip arthroplasty (THA) among primary THA and revision THA remains unclear. We hypothesized that most conversion THA’s can be performed using primary implants and will have an uncomplicated post-operative course. Materials and methods: Thirty-six patients (23 females, mean age 68,0y) who underwent conversion THA for failed interventions for proximal femur fractures in the period 2008–2018 were matched sequentially against patients of the same sex and age who underwent primary THA or revision THA. Data were collected on implants used, major complications, and mortality. PROMs used included the Western Ontario and McMaster Osteoarthritis Index, Harris Hip Score, Visual Analogue Scale and the EQ-5D Health Questionnaire. Results: Seventy-two percent of patients who underwent conversion THA were treated with primary implants and never suffered from a major complication. PROMs were excellent for this group of patients. The distinction primary/ conversion/revision THA could not explain differences in outcomes; however, the necessity of using revision implants and the development of major complications could. Conclusions: The majority of conversion total hip arthroplasties can be considered a primary replacement. Predicting outcomes for THA should focus on patient frailty and technical difficulties dealing with infection, stability and loss of bone stock and should discard the conversion versus revision terminology. Keywords: Proximal femur fracture, Total hip arthroplasty, Conversion, Primary, Revision, Matched cohort study Background A primary total hip arthroplasty (pTHA) is most commonly performed for osteoarthritis (OA), usually has an uneventful post-operative course and is known for its excellent long-term results [1]. Nevertheless, failures do occur, for a variety of reasons, and are most often followed by a revision (r) THA. This is a technically more demanding procedure, revision *Correspondence: [email protected] 1 Department of Trauma and Orthopaedics, University Mohammed Premier Oujda, Mohammed VI Oujda Morocco Hospital Center, Oujda University, BP 4806, 60049 Oujda, Morocco Full list of author information is available at the end of the article
implants are often necessary, and can range from changing a worn-out polyethylene liner in a not yet unstable hip to a two-stage revision for a difficult to treat infection with substantial bone loss. Results of rTHA’s are less favourable than those seen in pTHA’s due to the fact that complications are more common, survival of implants is shorter, and patients report lower on outcome measures (PROMs) [2–4]. A third group of hip replacements is made up by the conversion (c) THA’s. These are usually performed when an interv
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