ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1562576
This article is part of the Research TopicAdvances in Surgical and Basic Research in Hip Surgery: Complications, Artificial Intelligence and Surgery RoboticsView all 8 articles
Survival of Hybrid Total Hip Arthroplasty Implants After Proximal Femoral Nail Antirotation Failure: A Retrospective Study with 10-Year Median Follow-Up
Provisionally accepted
- 1The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
- 2Fuzhou Second Affiliated Hospital, Xiamen University, Fuzhou, Fujian Province, China
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Background: This study investigates the long-term outcomes of hybrid total hip arthroplasty (THA) in patients aged 50-80 years following failure of proximal femoral nail antirotation (PFNA) used for intertrochanteric femur fractures (IFFs). The primary objective was to evaluate implant survival, with secondary assessments of patient-reported outcomes and implant-related complications.Methods: A retrospective review was conducted across two medical centers, including 116 patients who underwent conversion from failed PFNA to hybrid THA between 2011 and 2023. The primary endpoint was revision-free implant survival, estimated using Kaplan-Meier analysis.Multivariable Cox regression was used to identify risk factors. Secondary endpoints included pain, satisfaction, EQ-VAS scores, and adverse events such as loosening, dislocation, and periprosthetic fracture.Results: Over a median follow-up of 10 years (range: 5-13 years), the estimated 10-year revisionfree survival rate was 90.1%. Patients aged 65-80 years exhibited a significantly higher risk of revision compared to those aged 50-65 (HR = 3.72, 95% CI: 4.86-6.12, p = 0.010). At the final follow-up, the mean pain score was 2.2 (95% CI: 2.1-2.4), satisfaction score was 3.6 (95% CI: 3.5-3.7), and EQ-VAS score was 78.6 (95% CI: 78.3-78.9). A total of 12 patients (10.3%) experienced implant-related complications, with stem loosening being the most common cause of revision.Conversion from failed PFNA to hybrid THA provides durable implant survival and favorable patient-reported outcomes over a 10-year period. The complication rate remains acceptably low. Age emerged as a significant predictor of revision risk, underscoring the importance of tailored surgical strategies in older patients undergoing PFNA conversion.
Keywords: Hip, Arthroplasty, Extracapsular, Outcome, Adverse event
Received: 17 Jan 2025; Accepted: 15 Jun 2025.
Copyright: © 2025 Yu, Lai, Xu and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Weiguang Yu, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
Xianshang Zeng, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
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