Total Hip Arthroplasty for Proximal Femoral Nonunion and Malunion

Nonunions and malunions may complicate the treatment of proximal femur fractures. These sequelae often occur in the setting of poor bone stock or a compromised host, thereby adding to the complexity of their presentation. Hip arthroplasty after failed fracture treatment (often referred to as “conversion arthroplasty”) can often be employed as a salvage procedure in these difficult clinical scenarios to improve pain and limitations in mobility. However, previously placed hardware may alter patient anatomy, create potential stress risers, and confer a higher risk for postoperative complications including infection and instability. These surgeries often require revision components and adjunctive techniques including trochanteric osteotomies or bone grafting. This chapter will outline the indications for conversion arthroplasty in the setting of proximal femoral nonunions and malunions, discuss technical pearls and pitfalls of these surgical interventions, and present their reported clinical outcomes.