Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 27:24:101243.
doi: 10.1016/j.artd.2023.101243. eCollection 2023 Dec.

Total Hip Arthroplasty After Proximal Femoral Nailing: Preoperative Preparation and Intraoperative Surgical Techniques

Simarjeet Puri  1 , Peter K Sculco  2 , Matthew P Abdel  3 , David S Wellman  4 , Elizabeth B Gausden  2
Affiliations

Total Hip Arthroplasty After Proximal Femoral Nailing: Preoperative Preparation and Intraoperative Surgical Techniques

Simarjeet Puri et al. Arthroplast Today. .

Abstract

The combination of an aging population and increased utilization of total hip arthroplasty (THA) is leading to a higher incidence of conversion THA, defined as conversion from previous hip fracture surgery to THA. Conversion THA is a more technically challenging, time-consuming, and costly procedure compared to primary THA and frequently involve more medically complex patients. Thus, the aim of this review is to provide a rubric for surgeons to use when preparing for a conversion THA. We have assessed the compatibility of commonly available extraction devices with popular femoral nails. Furthermore, we review technical pearls for conversion THA including equipment planning, operative setup, intraoperative imaging, extraction sequencing, and troubleshooting commonly encountered obstacles.

Keywords: Complex total hip arthroplasty; Conversion total hip arthroplasty; Surgical technique.

PubMed Disclaimer

Figures

Figure 1
Figure 1
AP (a) and lateral (b) radiograph of the right femur with Gamma nail (Stryker) demonstrating device failure due to superior cut-out and varus intertrochanteric fracture nonunion. (c) Characteristics that identify this nail as Gamma (Stryker) include the divots present at the lateral aspect of the lag screw to allow engagement of inserter and extractor as well as a similar divot (arrows) present proximally in nail itself. AP, anteroposterior.
Figure 2
Figure 2
An 83-year-old female presented with posttraumatic arthritis 9 months after short Trochanteric Femoral Nail Advanced (Depuy Synthes) for an intertrochanteric fracture. AP (a) and frog-leg lateral (b) radiographs demonstrate from time of presentation. Intraoperatively, the left femoral neck had over 50 degrees of anteversion indicating malunion of the fracture. Postoperative AP radiograph (c) demonstrates an implanted diaphyseal-engaging stem for deformity correction.
Figure 3
Figure 3
AP Radiograph of left femur with Intertan (Smith & Nephew) nail. This nail can be distinguished from its Stryker, Depuy-Synthes, and Zimmer counterparts by the presence of both a lag screw and compression screw, whereas most other cephalomedullary nails have a single lag screw or helical blade option.
Figure 4
Figure 4
Identifying the cephalomedullary nail via guidewire and fluoroscopy. Once the proximal aspect of a buried nail is identified and cannulated in this manner, a reamer can be used to clear bone and then the threads engaged.
Appendix Figure 1
Appendix Figure 1
Depuy Synthes Trochanteric Fixation Nail (a), Trochanteric Fixation Nail Advanced (b), Femoral Reconstruction Nail (c).
Appendix Figure 2
Appendix Figure 2
Zimmer Biomet Cephalomedullary Nail (a), Piriformis Nail (b), Affixus Nail (c).
Appendix Figure 3
Appendix Figure 3
Smith & Nephew Intertan Nail (a), Metatan Nail (b), Fan Nail (c).
Appendix Figure 4
Appendix Figure 4
Stryker Gamma Nail (a), T2 Reconstruction Nail (b), T2 Anterograde/Retrograde Nail (c).
Appendix Figure 5
Appendix Figure 5
Stryker 1806-6125 (a), 1806-0350 (b), 2351-0180 (c), 1407-4006 (d), 1806-6130 (e) extractors.
Appendix Figure 6
Appendix Figure 6
Zimmer Biomet conical, cannulated extractor (a) and 5/16 extractor (b).
Appendix Figure 7
Appendix Figure 7
Winquist conical extractor.
Appendix Figure 8
Appendix Figure 8
Smith & Nephew conical, cannulated universal extractor.
See this image and copyright information in PMC

References

    1. Shelton T., Hecht G., Slee C., Wolinsky P. A comparison of geriatric hip fracture databases. J Am Acad Orthop Surg. 2019;27:e135–e141. - PubMed
    1. Roberts K.C., Brox W.T., Jevsevar D.S., Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23:131–137. - PubMed
    1. Baghoolizadeh M., Schwarzkopf R. The Lawrence D. Dorr surgical techniques & technologies award: conversion total hip arthroplasty: is it a primary or revision hip arthroplasty. J Arthroplasty. 2016;31:16–21. - PubMed
    1. Douglas S.J., Remily E.A., Sax O.C., Pervaiz S.S., Delanois R.E., Johnson A.J. How does conversion total hip arthroplasty compare to primary? J Arthroplasty. 2021;36:S155–S159. - PubMed
    1. Smith A., Denehy K., Ong K.L., Lau E., Hagan D., Malkani A. Total hip arthroplasty following failed intertrochanteric hip fracture fixation treated with a cephalomedullary nail. Bone Jt. J. 2019;101-B:91–96. - PubMed

LinkOut - more resources