Risk Factors for Early Conversion Total Hip Arthroplasty After Pipkin IV Femoral Head Fracture

Kyle H Cichos; Parker A White; Patrick F Bergin; Elie S Ghanem; Gerald McGwin Jr; Jacob Hawkins; Clay A Spitler

doi:10.1097/BOT.0000000000002512

Risk Factors for Early Conversion Total Hip Arthroplasty After Pipkin IV Femoral Head Fracture

J Orthop Trauma. 2023 Apr 1;37(4):181-188. doi: 10.1097/BOT.0000000000002512.

Authors

Kyle H Cichos¹, Parker A White², Patrick F Bergin², Elie S Ghanem¹, Gerald McGwin Jr³, Jacob Hawkins¹, Clay A Spitler¹

Affiliations

¹ Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
² Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and.
³ Department of Epidemiology, UAB School of Public Health, Birmingham, AL.

PMID: 36730828
DOI: 10.1097/BOT.0000000000002512

Abstract

Objectives: To determine risk factors for early conversion total hip arthroplasty (THA) in Pipkin IV femoral head fractures.

Design: Retrospective cohort.

Setting: Two level I trauma centers.

Patients and intervention: One hundred thirty-seven patients with Pipkin IV fractures meeting inclusion criteria with 1 year minimum follow-up managed from 2009 to 2019.

Main outcome measurement: Patients were separated into groups by the Orthopaedic Trauma Association/AO Foundation (OTA/AO) classification of femoral head fracture: 31C1 (split-type fractures) and 31C2 (depression-type fractures). Multivariable regression was performed after univariate analysis comparing patients requiring conversion THA with those who did not.

Results: We identified 65 split-type fractures, 19 (29%) underwent conversion THA within 1 year. Surgical site infection ( P = 0.002), postoperative hip dislocation ( P < 0.0001), and older age ( P = 0.049) resulted in increased rates of conversion THA. However, multivariable analysis did not identify independent risk factors for conversion. There were 72 depression-type fractures, 20 (27.8%) underwent conversion THA within 1 year. Independent risk factors were increased age ( P = 0.01) and posterior femoral head fracture location ( P < 0.01), while infrafoveal femoral head fracture location ( P = 0.03) was protective against conversion THA.

Conclusion: Pipkin IV fractures managed operatively have high overall risk of conversion THA within 1 year (28.5%). Risk factors for conversion THA vary according to fracture subtype. Hip joint survival of fractures subclassified OTA/AO 31C1 likely depends on patient age and postoperative outcomes such as surgical site infection and redislocation. Pipkin IV fractures subclassified to OTA/AO 31C2 type with suprafoveal and posterior head impaction and older age should be counseled of high conversion risk with consideration for alternative management options.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Femoral Fractures* / surgery
Femur Head / injuries
Femur Head / surgery
Hip Fractures* / surgery
Humans
Retrospective Studies
Risk Factors
Surgical Wound Infection / surgery
Treatment Outcome