Abstract / Summary
Abstract Purpose We evaluated the clinical and radiographic outcomes of a standardized reconstructive protocol in conversion total hip arthroplasty (cTHA) for failure of proximal femur fractures with cephalomedullary nail (CMN) breakage using a cementless monoblock tapered fluted revision stem. Methods We included 20 patients who underwent cTHA between 2021 and 2024 using the same revision stem after failed proximal femur fixation with a broken CMN, with a minimum follow-up of 24 months. The primary outcomes were femoral stem performance, assessed by stem revision for any cause, and radiographic outcomes. Secondary outcomes included complications, revision for any cause, and functional outcomes. Associations between functional outcomes and age, complications, and ASA grade were also evaluated. Results The mean follow-up was 31.3 months. No stem subsidence > 5 mm, aseptic loosening, or stem revisions occurred. Hip biomechanics was satisfactorily restored. Six complications occurred, including two perioperative events, three early dislocations (two requiring revision surgery), and one traumatic periprosthetic fracture. Sixty percent of patients achieved good or excellent Oxford Hip Score (OHS), the mean Parker Mobility Scale (PMS) was 6.5 ± 1.9. Higher preoperative ASA grade was associated with worse postoperative OHS (ρ = −0.589, p = 0.006) and PMS (ρ = −0.485, p = 0.030). Conclusions Uncemented monoblock diaphyseal-engaging revision stems provide reliable femoral fixation in cTHA after failed CMN with nail breakage. Although complications were common, none involved stem failure. Functional outcomes are acceptable in most patients but remain associated with preoperative ASA status. Levels of evidence IV