# Salvage Total Hip Arthroplasty After Cephalomedullary Nail Failure Due to Nonunion in a Pertrochanteric Fracture: A 10-Year Follow-Up

## TL;DR

This paper presents a successful 10-year outcome of a hip replacement after a failed nail treatment for a broken hip in an elderly patient.

## Contribution

The study demonstrates the long-term effectiveness of converting to hip arthroplasty after Gamma nail failure due to nonunion.

## Key findings

- The patient achieved excellent functional recovery 10 years after salvage hip arthroplasty.
- Implant fixation remained stable with no loosening or complications over the 10-year follow-up.
- Successful outcome was achieved without the use of allogeneic blood transfusion.

## Abstract

Cephalomedullary nailing is a widely used treatment for pertrochanteric fractures because of its minimally invasive nature, low complication rate, and biomechanical advantages. However, nonunion remains a rare but severe complication that can lead to implant failure and eventual nail breakage.

We report the case of an 81-year-old patient who presented with implant failure following fixation of a pertrochanteric fracture with a Gamma cephalomedullary nail. Postoperatively, the patient developed nonunion, and nail breakage occurred 13 months after the initial surgery. Management was further complicated by the patient’s refusal of an allogeneic blood transfusion. The broken nail was removed, and the patient successfully underwent a cementless total hip arthroplasty. At the 10-year follow-up, a clinical examination confirmed excellent functional recovery, and plain radiographs showed stable implant fixation with no evidence of loosening or other complications.

This case highlights that conversion to total hip arthroplasty following nonunion-related Gamma nail breakage is a viable and effective option in elderly patients, providing long-term pain relief and stable implant survival, even in the absence of allogeneic blood transfusion.