{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T13:03:49Z","timestamp":1781269429857,"version":"3.54.1"},"reference-count":28,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Total hip arthroplasty (THA) is used as treatment of acute hip fracture and as a salvage procedure after failed internal fixation (IF). We aimed to assess revision rates of salvage-THA after IF of hip fracture compared with acute fracture-related THA.Methods:\u00a0Using the Dutch Arthroplasty Register, 32,960 procedures with fracture-related THAs of the proximal femur between 2007 and 2023 were selected. We performed competing risk survival analysis and adjusted multivariable Cox regression.Results:\u00a012,486 patients received salvage THA after failed IF, 744 (6.0%) needed revision THA; 18,450 patients received acute THA for fracture, 885 (4.8%) needed revision THA. Cumulative rates of revision THA after salvage THA at 1 and 5 years were 2.7% (95% confidence interval [CI] 2.4\u20133.1) and 4.5% (CI 4.1\u20134.9), respectively, comparable to 2.5% (CI 2.3\u20132.8) and 4.3% (CI 4.0\u20134.6), for revision THA after acute THA. Revision THA of salvage THA patients were more often younger, male, had higher BMI, lower ASA class, and were smokers. Posterolateral approach, reversed-hybrid fixation, and small femoral heads were more common, compared with revision after acute THA for fracture patients. In both groups, most common reasons for revision THA were infection, aseptic loosening, and dislocation. In the salvage THA, adjusted hazard ratios (HR) showed increased risk of revision THA for ASA class III\u2013IV (HR 1.6), high BMI (BMI &gt; 25, HR 1.6\u20132.1), reversed hybrid fixation (HR 1.3), and 22\u201328 mm femoral head size (HR 1.3). Cumulative second revision rates of salvage THA after IF at 1 and 5 years were 14.1% (CI 11.6\u201317.2) and 22.3% (CI 19.0\u201326.2), similar to the acute THA for fracture group.Conclusion:\u00a0Revision rates after salvage THA following IF were comparable to those after acute THA for fracture. Hence, previous internal fixation does not seem disadvantageous. However, both groups differed clearly in case mix.<\/jats:p>","DOI":"10.2340\/17453674.2026.46046","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:51:40Z","timestamp":1781268700000},"source":"Crossref","is-referenced-by-count":0,"title":["Salvage total hip arthroplasty after internal fixation compared with acute total hip arthroplasty for fracture: a cohort study based on 32,960 cases from the Dutch Arthroplasty Register"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4107-3404","authenticated-orcid":false,"given":"Laura","family":"Van Marle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1484-4226","authenticated-orcid":false,"given":"Rinne M","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8141-842X","authenticated-orcid":false,"given":"Liza N","family":"Van Steenbergen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4308-7815","authenticated-orcid":false,"given":"Ruurd L","family":"Jaarsma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job N","family":"Doornberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6410-3824","authenticated-orcid":false,"given":"Wierd P","family":"Zijlstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"158872","doi-asserted-by":"crossref","unstructured":"Zeelenberg M L, Den Hartog D, Panneman M J M, Polinder S, Verhofstad M H J, Van Lieshout E M M. Trends in incidence, health care consumption, and costs for proximal femoral fractures in the Netherlands between 2000 and 2019: a nationwide study. Osteoporos Int 2023; 34(8): 1389-99. doi: 10.1007\/s00198-023-06774-y.","DOI":"10.1007\/s00198-023-06774-y"},{"key":"158873","doi-asserted-by":"crossref","unstructured":"Rogmark C, Viberg B, Wolf O, Mukka S, Costa M L, Gjertsen J E. An Acta Orthopaedica educational article: Femoral neck fractures in adults with emphasis on surgical treatment. Acta Orthop 2025; 96: 632-9. doi: 10.2340\/17453674.2025.44354.","DOI":"10.2340\/17453674.2025.44354"},{"key":"158874","doi-asserted-by":"crossref","unstructured":"Hung C C, Chen K H, Chang C W, Chen Y C, Tai T W. Salvage total hip arthroplasty after failed internal fixation for proximal femur and acetabular fractures. J Orthop Surg Res 2023; 18(1): 45. doi: 10.1186\/s13018-023-03519-9.","DOI":"10.1186\/s13018-023-03519-9"},{"key":"158875","unstructured":"LROI. Annual report 2024. \u2018s Hertogenbosch: Landelijke Registratie Orthopedische Interventies; 2024."},{"key":"158876","doi-asserted-by":"crossref","unstructured":"Tate J P, Reinhart N M, Bridges C A, Brown N M, Sherman W F. Comparative outcomes of early versus late conversion to total hip arthroplasty following hip fracture fixation. J Arthroplasty 2025; 40(8): 2048-52.e4. doi: 10.1016\/j.arth.2025.01.015.","DOI":"10.1016\/j.arth.2025.01.015"},{"key":"158877","unstructured":"International Committee of Medical Journal Editors [homepage on the Internet]. Recommendations for the conduct, reporting, editing and publication of scholarly work in medical journals. Available from: http:\/\/www.ICMJE.org (accessed December 10, 2025)."},{"key":"158878","doi-asserted-by":"crossref","unstructured":"Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019; 13(Suppl 1): S31-s4. doi: 10.4103\/sja.SJA_543_18.","DOI":"10.4103\/sja.SJA_543_18"},{"key":"158879","doi-asserted-by":"crossref","unstructured":"Van Steenbergen L N, M\u00e4kel\u00e4 K T, K\u00e4rrholm J, Rolfson O, Overgaard S, Furnes O, et al. Total hip arthroplasties in the Dutch Arthroplasty Register (LROI) and the Nordic Arthroplasty Register Association (NARA): comparison of patient and procedure characteristics in 475,685 cases. Acta Orthop 2021; 92(1): 15-22. doi: 10.1080\/17453674.2020.1843875.","DOI":"10.1080\/17453674.2020.1843875"},{"key":"158880","doi-asserted-by":"crossref","unstructured":"Sayers A, Evans J T, Whitehouse M R, Blom A W. Are competing risks models appropriate to describe implant failure? 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Patient and implant survival following 4323 total hip replacements for acute femoral neck fracture: a retrospective cohort study using National Joint Registry data. J Bone Joint Surg Br 2012; 94(11): 1557-66. doi: 10.1302\/0301-620x.94b11.29689.","DOI":"10.1302\/0301-620X.94B11.29689"},{"key":"158886","doi-asserted-by":"crossref","unstructured":"Hailer N P, Garland A, Rogmark C, Garellick G, K\u00e4rrholm J. Early mortality and morbidity after total hip arthroplasty in patients with femoral neck fracture. Acta Orthop 2016; 87(6): 560-6. doi: 10.1080\/17453674.2016.1234869.","DOI":"10.1080\/17453674.2016.1234869"},{"key":"158887","doi-asserted-by":"crossref","unstructured":"Di Martino A, D\u2019Agostino C, Poluzzi R, Brunello M, Geraci G, Traina F, et al. Outcomes and complications of conversion THA after internal fixation of proximal femur fractures: a systematic review. Eur J Trauma Emerg Surg 2025; 51(1): 293. doi: 10.1007\/s00068-025-02977-6.","DOI":"10.1007\/s00068-025-02977-6"},{"key":"158888","doi-asserted-by":"crossref","unstructured":"Schmitz P P, Hannink G, Somford M P, Schreurs B W, Van Susante J L C. Revision risk of salvage compared with acute total hip arthroplasty following femoral neck fracture: an analysis from the Dutch Arthroplasty Register. Acta Orthop 2023; 94: 399-403. doi: 10.2340\/17453674.2023.17743.","DOI":"10.2340\/17453674.2023.17743"},{"key":"158889","doi-asserted-by":"crossref","unstructured":"Mahmoud S S, Pearse E O, Smith T O, Hing C B. Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis. Bone Joint J 2016; 98-b(4): 452-60. doi: 10.1302\/0301-620x.98b4.36922.","DOI":"10.1302\/0301-620X.98B4.36922"},{"key":"158890","doi-asserted-by":"crossref","unstructured":"Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 2017; 14(3): 529-36. doi: 10.1111\/iwj.12640.","DOI":"10.1111\/iwj.12640"},{"key":"158891","doi-asserted-by":"crossref","unstructured":"Lamb J N, West R M, Relton S D, Wilkinson J M, Pandit H G. The risk of postoperative periprosthetic femoral fracture after total hip arthroplasty depends more on stem design than cement use: an analysis of National Health data from England. J Bone Joint Surg Am 2025; 107(5): 476-87. doi: 10.2106\/jbjs.24.00894.","DOI":"10.2106\/JBJS.24.00894"},{"key":"158892","doi-asserted-by":"crossref","unstructured":"Madariaga S, Vargas-Rever\u00f3n C, Tornero E, Al\u00edas A, Capurro B, Combalia A, et al. 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