Clinical outcomes of the single-stage revision technique in conversion total hip arthroplasty after failed femoral neck fractures: a two-year follow-up study

TL;DR

A study found that a single-stage revision technique during hip replacement surgery after failed femoral neck fractures may lower infection rates compared to traditional methods.

Contribution

The study introduces the single-stage revision technique as a novel approach to reduce periprosthetic joint infections in conversion total hip arthroplasty.

Findings

Group B (single-stage revision) had a 1% infection rate compared to 7% in Group A.

91% of Group B patients had no unexpected positive intraoperative cultures.

The technique shows potential for reducing periprosthetic joint infections in this clinical scenario.

Abstract

Conversion to total hip arthroplasty (THA) is associated with higher rates of infection. The purpose of this study is to determine whether applying the surgical technique of single-stage revision can effectively reduce the infection rate of conversion THA after failed femoral neck fractures.

A retrospective cohort study was conducted on patients who underwent conversion THA after failed femoral neck fracture between January 2019 and December 2022, with a minimum follow-up of 2 years. From January 2019 to March 2020, patients undergoing conversion THA were managed as a primary procedure without synovial fluid culture (Group A). From April 2020 to December 2022, patients undergoing conversion THA were managed with the single-stage revision technique and routine intraoperative synovial fluid culture (Group B). The patients in Group B were matched 1:1 to patients in Group A. Unexpected positive intraoperative culture (UPIC) results were recorded, and PJIs were monitored during the minimum 2-year follow-up period.

As intraoperative cultures were only performed in Group B, the unexpected positive intraoperative culture (UPIC) results presented were solely for Group B. Among the patients in Group B who underwent conversion THA, 91% had no UPIC (90 of 99), 7% had a single (either anaerobic bottle or aerobic bottle) UPIC (7 of 99), and 2% had two (both anaerobic and aerobic bottles) UPICs (2 of 99). In Group A, 7 patients (7/99, 7%) experienced PJIs, compared to 1 patient (1/99, 1%) in Group B, showing a significant difference between the two groups (P = 0.030).

As a novel method for conversion to THA after failed femoral neck fracture, the single-stage revision technique is potentially associated with a lower incidence of PJI. Further evaluation of this technique in larger comparative series is warranted.

Video Abstract

Video Abstract

The online version contains supplementary material available at 10.1186/s42836-025-00364-5.

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