Functional outcomes of salvage hip arthroplasty in failed proximal femoral nails: a retrospective cohort study

PURPOSE: Intertrochanteric femur fractures treated with proximal femoral nails (PFNs) may develop complications such as screw cutout, nonunion, and varus collapse, which can necessitate salvage procedures including hip arthroplasty. This study aimed to evaluate the surgical challenges, operative techniques, and outcomes of hip arthroplasty performed after failed PFN fixation. METHODS: A total of 59 patients who underwent hip arthroplasty following PFN failure for intertrochanteric femur fractures were enrolled. Collected data included patient demographics, fracture characteristics, PFN failure patterns, surgical techniques, complications, and functional outcomes. RESULTS: The most common PFN failure patterns were screw backout, cutout, screw breakage, and nail breakage. These cases were managed with salvage hip arthroplasty, including hemiarthroplasty and total hip arthroplasty, depending on patient-specific factors. Intraoperative challenges involved implant removal and management of bone defects. Reported complications included dislocation, deep vein thrombosis, and periprosthetic fractures. The mean Harris Hip Score at 24 months was 79.2. CONCLUSIONS: Hip arthroplasty serves as an effective salvage option for failed PFN fixation in intertrochanteric femur fractures. However, it presents distinct surgical challenges and requires careful patient selection and meticulous technique to reduce the risk of complications.