Correlation between perioperative surgical factors and complications after hip arthroplasty, as a salvage procedure, following failure of internal fixation of osteoporotic intertrochanteric fractures.

Background And Purpose: Salvage hip arthroplasty (SHA) in patients presenting with failed internal fixation after intertrochanteric fracture (FIF-ITFx) is a difficult procedure, and the incidence of perioperative mortality and complications following SHA are high. To our knowledge, no information related to the correlation between perioperative surgical factors and post-SHA perioperative complications in these patients has been demonstrated. This study aimed to identify the predictive factors for post-SHA perioperative complications in patients with FIF-ITFx.

Materials And Methods: A total of 32 patients with FIF-ITFx who underwent SHA between 2010 and 2017 were retrospectively reviewed. All patients had been followed for 1 year post-operatively. Perioperative data and complication details related to fracture and treatment were collected. Predictive factors for post-SHA perioperative complications were analyzed via logistic regression analysis.

Results: Two (6%) patients died after SHA during the admission period. Perioperative complications were found in 16 (50%) patients, including surgical (n=3, 9%) and medical (n=15, 47%) complications, respectively. By univariate analysis, age (=0.043), American Society of Anesthesiologist (ASA) grade 4 (=0.016), Charlson Comorbidity Index (CCI; =0.014), lymphocyte cell count (=0.064), and serum albumin level (=0.146) were correlated with the perioperative complications. However, multivariate regression analysis showed that CCI was the only significant independent predictor for post-SHA perioperative complications in these patients (OR=1.87; 95% CI, 1.14-2.07, =0.014).

Conclusion: Our study showed that post-SHA perioperative complications in patients with FIF-ITFx are very common and predictable with a simple preoperative factor CCI. Therefore, special perioperative attention must be paid to patients with FIF-ITFx undergoing SHA and having multiple severe comorbid diseases or high CCI.