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Li X, Jiang HY, Zhao YJ, Liu SZ, Pan LX. Establishment and validation of a nomogram to predict postoperative anemia after total hip arthroplasty. BMC Musculoskelet Disord 2024; 25:141. [PMID: 38355520 PMCID: PMC10865598 DOI: 10.1186/s12891-024-07264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Anemia is a common complication of total hip arthroplasty (THA). In this study, we evaluated the preoperative risk factors for postoperative anemia after THA and developed a nomogram model based on related preoperative and intraoperative factors. METHODS From January 2020 to May 2023, 927 THA patients at the same medical center were randomly assigned to either the training or validation cohort. The correlation between preoperative and intraoperative risk factors and postoperative anemia after THA was evaluated using univariate and multivariate logistic regression analysis. A nomogram was developed using these predictive variables. The effectiveness and validation for the clinical application of this nomogram were evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS Through univariate and multivariate logistic regression analysis, 7 independent predictive factors were identified in the training cohort: Lower body mass index (BMI), extended operation time, greater intraoperative bleeding, lower preoperative hemoglobin level, abnormally high preoperative serum amyloid A (SAA) level, history of cerebrovascular disease, and history of osteoporosis. The C-index of the model was 0.871, while the AUC indices for the training and validation cohorts were 84.4% and 87.1%, respectively. In addition, the calibration curves of both cohorts showed excellent consistency between the observed and predicted probabilities. The DCA curves of the training and validation cohorts were high, indicating the high clinical applicability of the model. CONCLUSIONS Lower BMI, extended operation time, increased intraoperative bleeding, reduced preoperative hemoglobin level, elevated preoperative SAA level, history of cerebrovascular disease, and history of osteoporosis were seven independent preoperative risk factors associated with postoperative anemia after THA. The nomogram developed could aid in predicting postoperative anemia, facilitating advanced preparation, and enhancing blood management. Furthermore, the nomogram could assist clinicians in identifying patients most at risk for postoperative anemia.
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Affiliation(s)
- Xiang Li
- Department of Orthopedics and Sports Medicine, Li Huili Hospital Affiliated to Ningbo University, 1111 Jiangnan Street, Ningbo, 315000, China
- Health Science Center, Ningbo University, 818 Fenghua Street, Ningbo, 315211, China
| | - Hong-Yang Jiang
- Department of Orthopedics and Sports Medicine, Li Huili Hospital Affiliated to Ningbo University, 1111 Jiangnan Street, Ningbo, 315000, China
- Health Science Center, Ningbo University, 818 Fenghua Street, Ningbo, 315211, China
| | - Yong-Jie Zhao
- Department of Orthopedics and Sports Medicine, Li Huili Hospital Affiliated to Ningbo University, 1111 Jiangnan Street, Ningbo, 315000, China
- Health Science Center, Ningbo University, 818 Fenghua Street, Ningbo, 315211, China
| | - Si-Zhuo Liu
- Department of Orthopedics and Sports Medicine, Li Huili Hospital Affiliated to Ningbo University, 1111 Jiangnan Street, Ningbo, 315000, China
- Health Science Center, Ningbo University, 818 Fenghua Street, Ningbo, 315211, China
| | - Ling-Xiao Pan
- Department of Orthopedics and Sports Medicine, Li Huili Hospital Affiliated to Ningbo University, 1111 Jiangnan Street, Ningbo, 315000, China.
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Wang W, Yao W, Tang W, Li Y, Sun H, Ding W. Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1360058. [PMID: 38405191 PMCID: PMC10884186 DOI: 10.3389/fmed.2024.1360058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures. Methods A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers. Results Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57). Conclusion Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management. Systematic review registration identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.
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Affiliation(s)
| | | | | | | | - Hongbo Sun
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
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Okike K, Prentice HA, Chan PH, Fasig BH, Paxton EW, Bernstein J, Ahn J, Chen F. Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals. J Bone Joint Surg Am 2024; 106:120-128. [PMID: 37973035 DOI: 10.2106/jbjs.23.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Practice patterns regarding the use of unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (THA) for femoral neck fractures in older patients vary widely. This is due in part to limited data stipulating the specific circumstances under which each form of arthroplasty provides the most predictable outcome. The purpose of this study was to investigate the patient characteristics for which unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA might be preferable due to a lower risk of all-cause revision. METHODS A U.S. health-care system's hip fracture registry was used to identify patients ≥60 years old who underwent unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA for hip fracture from 2009 through 2021. Unipolar and bipolar hemiarthroplasty were compared with THA within patient subgroups defined by age (60 to 79 versus ≥80 years) and American Society of Anesthesiologists (ASA) classification (I or II versus III); patients with an ASA classification of IV or higher were excluded. Multivariable Cox proportional hazard regression analysis was used to evaluate all-cause revision risk while adjusting for confounders, with mortality considered as a competing risk. RESULTS There were 14,277 patients in the final sample (median age, 82 years; 70% female; 80% White; 69% with an ASA classification of III; median follow-up, 2.7 years), and the procedures included 7,587 unipolar hemiarthroplasties, 5,479 bipolar hemiarthroplasties, and 1,211 THAs. In the multivariable analysis of all patients, both unipolar (hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.48 to 3.12; p < 0.001) and bipolar (HR = 1.92, 95% CI = 1.31 to 2.80; p < 0.001) hemiarthroplasty had higher revision risks than THA. In the age-stratified multivariable analysis of patients aged 60 to 79 years, both unipolar (HR = 2.17, 95% CI = 1.42 to 3.34; p = 0.004) and bipolar (HR = 1.69, 95% CI = 1.08 to 2.65; p = 0.022) hemiarthroplasty also had higher revision risks than THA. In the ASA-stratified multivariable analysis, patients with an ASA classification of I or II had a higher revision risk after either unipolar (HR = 3.52, 95% CI = 1.87 to 6.64; p < 0.001) or bipolar (HR = 2.31, 95% CI = 1.19 to 4.49; p = 0.013) hemiarthroplasty than after THA. No difference in revision risk between either of the hemiarthroplasties and THA was observed among patients with an age of ≥80 years or those with an ASA classification of III. CONCLUSIONS In this study of hip fractures in older patients, THA was associated with a lower risk of all-cause revision compared with unipolar and bipolar hemiarthroplasty among patients who were 60 to 79 years old and those who had an ASA classification of I or II. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kanu Okike
- Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu, Hawaii
| | - Heather A Prentice
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Priscilla H Chan
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Brian H Fasig
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Joseph Bernstein
- Department of Orthopaedic Surgery, Philadelphia Veterans Hospital, Philadelphia, Pennsylvania
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Foster Chen
- Department of Orthopaedic Surgery, Washington Permanente Medical Group P.C., Seattle, Washington
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Lee SH, Kwak DK, Yoo JH. Surgical drain has no benefits in hemiarthroplasty for femoral neck fractures in elderly patients. Sci Rep 2023; 13:21422. [PMID: 38049442 PMCID: PMC10696039 DOI: 10.1038/s41598-023-48799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
Femoral neck fracture is a common osteoporotic fracture in elderly patients and is effectively managed with arthroplasty. However, the benefits and risks of a surgical drain after arthroplasty in these patients are still debatable. Hence, we conducted this study to investigate the necessity of a surgical drain after hemiarthroplasty in elderly patients with femoral neck fracture. This study enrolled elderly patients (aged ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fracture between April 2016 and December 2021. The patients were divided into two groups; the control group (199 patients) with a surgical drain after surgery performed between April 2016 and June 2020 and the study group (134 patients) with no surgical drain between July 2020 and December 2021. The demographics, perioperative data, and postoperative complications were compared between the two groups. Estimated blood loss, perioperative transfusion volume and rate, and length of hospital stay were significantly lower in the study group than in the control group (p < 0.001, p < 0.001, p = 0.008, and p < 0.001, respectively). Although there were no significant intergroup differences in the length of intensive care unit stay and in-hospital, 1-month, and 1-year mortalities, the incidence of postoperative medical complications was significantly lower in the study group than the control group (p = 0.001). A surgical drain may be unnecessary after hemiarthroplasty in elderly patients with femoral neck fracture considering less blood loss and transfusion, lower incidence of postoperative medical complications, and shorter hospital stay in the study group with no surgical drain.
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Affiliation(s)
- Seung-Hun Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, South Korea
| | - Dae-Kyung Kwak
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, South Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, South Korea.
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Pangaud C, Pioger C, Pauly V, Orleans V, Boyer L, Argenson JN, Ollivier M. Response to the letter from Roger Erivan and Guillaume Villate. Orthop Traumatol Surg Res 2023; 109:103670. [PMID: 37517470 DOI: 10.1016/j.otsr.2023.103670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Corentin Pangaud
- Institut du mouvement et de l'appareil locomoteur UMR 7287, Aix-Marseille université et CNRS, 270, boulevard St-Marguerite, 13009 Marseille, France; Assistance publique des Hôpitaux de Marseille, 80, rue Brochier, 13005 Marseille, France.
| | - Charles Pioger
- Assistance publique des Hôpitaux de Paris, hôpital Ambroise-Paré, 9, avenue Charles de Gaulles, 92100 Boulogne Billancourt, France
| | - Vanessa Pauly
- Département de santé publique, Assistance publique des Hôpitaux de Marseille, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Veronica Orleans
- Département de santé publique, Assistance publique des Hôpitaux de Marseille, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Laurent Boyer
- Département de santé publique, Assistance publique des Hôpitaux de Marseille, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Jean-Noël Argenson
- Institut du mouvement et de l'appareil locomoteur UMR 7287, Aix-Marseille université et CNRS, 270, boulevard St-Marguerite, 13009 Marseille, France; Assistance publique des Hôpitaux de Marseille, 80, rue Brochier, 13005 Marseille, France
| | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur UMR 7287, Aix-Marseille université et CNRS, 270, boulevard St-Marguerite, 13009 Marseille, France; Assistance publique des Hôpitaux de Marseille, 80, rue Brochier, 13005 Marseille, France
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Gnanendran D, Yanaganasar Y, Rajan JM, Hassan ZB, Balbir Singh N, Min Yi L, Nadzree MF. Clinical Effectiveness of Total Hip Arthroplasty Compared With Hemiarthroplasty in Adults Undergoing Surgery for Displaced Intracapsular Hip Fracture: A Single-Centre Retrospective Cohort Study. Cureus 2023; 15:e45807. [PMID: 37876402 PMCID: PMC10591270 DOI: 10.7759/cureus.45807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommends offering total hip arthroplasty (THA) over hemiarthroplasty (HA) for displaced intracapsular hip fractures, taking the premorbid functionality, present co-morbidities, and functional benefit beyond two years into account. Concerns remain whether the higher surgical burden and incidence of complications in THA would outweigh the potential benefits in the elderly. METHOD This retrospective cohort study evaluates the differences in surgical outcomes of THA vs HA in 85 patients with displaced intracapsular fractures, based on the time taken for patients to ambulate to walking frame/crutches and wheelchair post-operatively and the incidence of post-operative complications. RESULTS Patients who received HA were significantly older (p<0.0001, <0.05) and had poorer pre-operative ambulatory function (p=0.032, p<0.05) than those of the THA group. HA patients had a significantly faster recovery to walking frame/crutches (20.2 days) compared to THA patients (47.3 days) (Mann-Whitney U=447.500, n=46, p=0.043, <0.05 two-tailed). While no significant differences were found in deep vein thrombosis (DVT), infected prosthesis, or dislocation incidence, hospital-acquired pneumonia (HAP) was more prevalent in THA patients (p=0.044, <0.05). Time to the walking frame had a significant effect on DVT/PE (p<0.001, CONCLUSION HA patients showed favourable outcomes in time to ambulate post-operatively and incidence of HAP among patients with advanced age and those with poorer pre-operative ambulatory function.
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Affiliation(s)
| | | | | | | | | | - Lau Min Yi
- Trauma and Orthopaedics, Hospital Sultan Ismail, Johor Bahru, MYS
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Domingue G, Warren D, Koval KJ, Riehl JT. Complications of Hip Hemiarthroplasty. Orthopedics 2023; 46:e199-e209. [PMID: 36719411 DOI: 10.3928/01477447-20230125-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [Orthopedics. 2023;46(4):e199-e209.].
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Pangaud C, Pioger C, Pauly V, Orleans V, Boyer L, Argenson JN, Ollivier M. Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture. Orthop Traumatol Surg Res 2023; 109:103575. [PMID: 36754167 DOI: 10.1016/j.otsr.2023.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Femoral neck fracture in the elderly patient can either be managed using hemi-arthroplasty (HA) or total hip arthroplasty (THA). The aim of this study was to explore the rate of three selected complications in each procedure: is the dislocation rate higher with HA compared to THA? Is the blood transfusion rate higher with THA compared to HA? Do the patients who underwent THA require more ICU transfer than the patients who underwent HA? Is the ICU transfer correlated to the use of cement for stem fixation? METHOD Based on a national health-care database, a comparative and retrospective study was conducted. 96,184 patients were included after having a surgery for femoral neck fracture between 2014 and 2017. The mean follow up was 3.5 years (Min. 2 years-Max. 5 years). The population was divided into two groups: hemiarthroplasty (HA) and total hip arthroplasty (THA). The primary outcome was the dislocation rate and the secondary outcomes were the blood transfusion rate and the need for ICU after surgery. RESULTS At two years of follow up in the Hemiarthroplasty group, 3647 patients had a dislocation episode over 64,106 patients: 5.69%. In the Total Hip Arthroplasty group: 1904 patients had a dislocation episode over 32,078 patients: 5.94% (p=0.26711). The percentage of deceased patient without dislocation was 17.76% in the HA group and 11.56% in the THA group (p<0.001). The univariate hazard ratio for dislocation was higher in the THA group: HR 1.063 IC 95% (0.993-1.138) p=0.077. The multivariate analysis calculating competitive risk with death and dislocation found THA to be a protective factor of dislocation HR 0.926 IC 95% (0.866-0.991) p=0.0266. The rate of blood transfusion was 5.59% in the THA group and 7.03% in the HA group (p<0.001), The multivariate analysis found HR=1.062 IC 95% (0.99-1.139) p=0.0955. The need for ICU transfer after the surgery was 7.04% in the HA group and 8.08% in the THA group (p<0.001). The multivariate analysis found HR 0.995 IC 95% (0.921-1.076) p=0.9094. Finally, only cement was found as an independent risk factor of ICU transfer after surgery: HR 1.254 IC 95% (1.164-1.35) p<0.0001. CONCLUSION THA for femoral neck fracture allows to reduce the risk of dislocation compared to hemiarthroplasty. The multivariate analysis failed to prove the superiority of one procedure over the other regarding blood transfusion risk and the need for ICU transfer. The use of cemented stem appears to be a risk factor of ICU transfer after hip arthroplasty. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Corentin Pangaud
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France.
| | - Charles Pioger
- Public Teaching Hospital of Paris, Ambroise-Paré Hospital, Paris, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Veronica Orleans
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Jean Noël Argenson
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
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Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, Steinbrueck A, Rupp M. Infection after intracapsular femoral neck fracture - does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty? Bone Joint Res 2023; 12:331-338. [PMID: 37191182 DOI: 10.1302/2046-3758.125.bjr-2022-0314.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Aims The aim of this investigation was to compare risk of infection in both cemented and uncemented hemiarthroplasty (HA) as well as in total hip arthroplasty (THA) following femoral neck fracture. Methods Data collection was performed using the German Arthroplasty Registry (EPRD). In HA and THA following femoral neck fracture, fixation method was divided into cemented and uncemented prostheses and paired according to age, sex, BMI, and the Elixhauser Comorbidity Index using Mahalanobis distance matching. Results Overall in 13,612 cases of intracapsular femoral neck fracture, 9,110 (66.9%) HAs and 4,502 (33.1%) THAs were analyzed. Infection rate in HA was significantly reduced in cases with use of antibiotic-loaded cement compared with uncemented fixated prosthesis (p = 0.013). In patients with THA no statistical difference between cemented and uncemented prosthesis was registered, however after one year 2.4% of infections were detected in uncemented and 2.1% in cemented THA. In the subpopulation of HA after one year, 1.9% of infections were registered in cemented and 2.8% in uncemented HA. BMI (p = 0.001) and Elixhauser Comorbidity Index (p < 0.003) were identified as risk factors of periprosthetic joint infection (PJI), while in THA cemented prosthesis also demonstrated an increased risk within the first 30 days (hazard ratio (HR) = 2.73; p = 0.010). Conclusion The rate of infection after intracapsular femoral neck fracture was statistically significantly reduced in patients treated by antibiotic-loaded cemented HA. Particularly for patients with multiple risk factors for the development of a PJI, the usage of antibiotic-loaded bone cement seems to be a reasonable procedure for prevention of infection.
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Affiliation(s)
- Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Paula Krull
- Deutsches Endoprothesenregister gGmbH, Berlin, Germany
| | | | | | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Arnd Steinbrueck
- Deutsches Endoprothesenregister gGmbH, Berlin, Germany
- Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Lu H, Zhu N, Ling T, Cao J, Xu H, Zhou K, Zhao E, Zhou Z. Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2-14 years' follow-up of 345 patients. J Orthop Surg Res 2023; 18:341. [PMID: 37161494 PMCID: PMC10169472 DOI: 10.1186/s13018-023-03827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture. METHODS This study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years. RESULTS The two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001). CONCLUSIONS THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Niu Zhu
- Precision Medicine Center, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tingxian Ling
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jian Cao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kai Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Enze Zhao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
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11
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Szymski D, Walter N, Krull P, Melsheimer O, Lang S, Grimberg A, Alt V, Steinbrück A, Rupp M. The Prophylactic Effect of Single vs. Dual Antibiotic-Loaded Bone Cement against Periprosthetic Joint Infection Following Hip Arthroplasty for Femoral Neck Fracture: An Analysis of the German Arthroplasty Registry. Antibiotics (Basel) 2023; 12:antibiotics12040732. [PMID: 37107094 PMCID: PMC10135143 DOI: 10.3390/antibiotics12040732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Antibiotic-loaded bone cement in arthroplasties is currently experiencing increased usage. Therefore, single and double antibiotic-loaded bone cements are commercially available and used in orthopedic surgery. The aim of this investigation was to compare the clinical use of single compared to dual antibiotic-loaded bone cement for implant fixation after femoral neck fracture. Further infection rates were to be compared in (partial) arthroplasty for the treatment of femoral neck fracture for both treatment options. METHODS On the basis of the German Arthroplasty Registry (EPRD), all cases of femoral neck fracture treated with hemiarthroplasty (HA), or total hip arthroplasty (THA) with single and dual antibiotic-loaded bone cement, were included into the data analysis. The infection risk was compared using Kaplan-Meier estimates. RESULTS In total, 26,845 cases (HA 76.3%-THA: 23.7%) with femoral neck fracture were included. Within recent years, an increasing usage of dual antibiotic-loaded cement in Germany, with a current proportion of 7.30% in arthroplasty procedures for femoral neck fracture treatment, has been observed. In patients treated with HA, the proportion of dual antibiotic-loaded cement was 7.86%, while in those treated with THA, 5.46% of all prostheses were fixated with a two antibiotic component cement. For all arthroplasty procedures using single antibiotic-loaded bone cement after six months 1.8%, after one year 1.9%, and after five years 2.3%, of the cases failed due to periprosthetic joint infection (PJI), while in the same time period, in cases with dual antibiotic-loaded bone cement 1.5%, 1.5% and 1.5% suffered from infection (p = 0.34). A infection rate of 1.1% after HA with dual antibiotic-loaded bone cement was reported, compared to a 2.1% infection rate whilst using single antibiotic-loaded bone cement after five years (p = 0.098). The number required for treatment when using HA was 91. CONCLUSIONS The use of dual antibiotic-loaded bone cement is increasingly used in arthroplasty procedures after femoral neck fractures. It demonstrates a reduction of PJI after HA and seems, therefore, to be a useful method for the prevention of infection, especially in patients with increased risk factors for PJI.
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Affiliation(s)
- Dominik Szymski
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Nike Walter
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Paula Krull
- Deutsches Endoprothesenregister (EPRD) gGmbH, 10623 Berlin, Germany
| | | | - Siegmund Lang
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | | | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Arnd Steinbrück
- Deutsches Endoprothesenregister (EPRD) gGmbH, 10623 Berlin, Germany
- Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), 86152 Augsburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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12
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Lee R, Lee D, Heyer JH, Richards S, Hughes AJ, Schumer GB, Shincovich CI, Pandarinath R. Hip hemiarthroplasty for the treatment of femoral neck fractures in dialysis patients. Hip Int 2023; 33:338-344. [PMID: 34311615 DOI: 10.1177/11207000211028151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study sought to delineate the postoperative outcomes in dialysis patients undergoing hip hemiarthroplasty (HHA) for the treatment of femoral neck fractures (FNF) in order to better optimise pre- and postoperative management and minimise short-term morbidity and mortality rates. METHODS 16,955 patients who had undergone HHA for femoral neck fractures from 2005 to 2018 were isolated from a multi-institutional surgical registry, of which 343 (2.0%) were on dialysis and 16,612 (98.0%) were not. The cohorts were identified/analysed for differences in their comorbidities, demographic factors, and 30-day postoperative complications using Fischer's exact tests and Mann-Whitney U-tests. Coarsened exact matching (CEM) was implemented in order to control for baseline difference in demographics and comorbidities. Multivariate logistic regression analyses were used to assess the impact of dialysis as an independent risk factor for various complications, including reoperations, readmissions, and mortality. RESULTS Upon CEM-matching (L1-statistic <0.001), weighted multivariate logistic regression analyses demonstrated dialysis to be an independent risk factor for minor complications (OR 3.051, p < 0.001), pneumonia (OR 3.943, p < 0.001), urinary tract infections (UTIs) (OR 2.684, p < 0.001), major complications (OR 1.892, p < 0.001), unplanned intubation (OR 2.555, p = 0.047), cardiac arrest (OR 11.897, p < 0.001), deep vein thrombosis (DVT), (OR 2.610, p = 0.049), and mortality (OR 2.960, p < 0.001). CONCLUSIONS Dialysis independently increased the risk for unplanned intubation, cardiac arrest, blood transfusions, pneumonia, DVT, and mortality. In communicating postoperative expectations, surgeons should aim to clarify the patients' preferences and potential resuscitation designations prior to surgical intervention due to the increased risk of serious complications. A lower threshold of suspicion for DVT in this population is reasonable. Identifying high-risk patient populations that may experience increased rates of complications, with the ensuing financial expenditures, due to medical complexity rather than subpar management may help providers avoid penalties in caring for these patients.
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Affiliation(s)
- Ryan Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
| | - Jessica H Heyer
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Richards
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alice J Hughes
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Grace B Schumer
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Christina I Shincovich
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Rajeev Pandarinath
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
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13
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Phruetthiphat OA, Pinijprapa P, Satravaha Y, Kitcharanant N, Pongchaiyakul C. An innovative scoring system for predicting an excellent Harris hip score after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture. Sci Rep 2022; 12:19939. [PMID: 36402794 PMCID: PMC9675850 DOI: 10.1038/s41598-022-24177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
Typically, intramedullary and extramedullary devices are used to treat elderly with intertrochanteric fractures. The majority of previous research has focused on the association between surgical factors and mechanical failure after internal fixation. There is, however, limited evidence to demonstrate the association between functional outcomes after proximal femoral nail anti-rotation (PFNA) fixation and the non-surgical factors such as patient's comorbidities. The aim of this study is to determine the predictive factors associated with excellent outcome, as well as to develop an integrated scoring system to predict the outcome after PFNA fixation in elderly patients with an intertrochanteric fracture. A retrospective study was conducted between January 2012 and December 2018. Elderly patients with low-energy intertrochanteric fractures who underwent PFNA fixation and at least a year of follow-up were recruited. Demographics, comorbidities, cognitive status, time to operation, and surgical parameters of the patients were all identified. Excellent and non-excellent outcomes were assessed by Harris Hip Score (HHS) after a one-year follow up. Regression analysis was used to determine the predictors for an excellent functional outcome. A new integrated scoring system (ISSI; Integrate Scoring System in elderly patients with Intertrochanteric fracture) was developed and validated. 450 elderly patients were randomly divided into two cohorts: a development (N = 225) and validation cohorts (N = 225). In this study, age < 85 years, normal weight/overweight, Charlson comorbidity index (CCI) < 6, no cognitive impairment, a modified AO/OTA 31A1.3, time to operation < 6 days, and Tip Apex Distance between 20 and 30 mm were significantly associated with an excellent outcome after PFNA fixation. The range of ISSI score was between 0 to 16 and the cut-off score of 13 was found to have the highest discriminatory power to determine the excellent functional outcome where the area of ROC was 0.85. In regards to the validation cohort, the sensitivity and specificity of ISSI score was 69% and 87%, respectively, and the AUC was 0.81. The ISSI score is effortless and practical for orthopedic surgeons for predicting an outcome after PFNA fixation in elderly patients with an intertrochanteric fracture.
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Affiliation(s)
- Ong-art Phruetthiphat
- grid.414965.b0000 0004 0576 1212Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
| | - Panukorn Pinijprapa
- grid.414965.b0000 0004 0576 1212Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
| | - Yodhathai Satravaha
- grid.10223.320000 0004 1937 0490Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nitchanant Kitcharanant
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Chiang Mai University, Chiang Mai, Thailand
| | - Chatlert Pongchaiyakul
- grid.9786.00000 0004 0470 0856Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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14
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Zhu J, Hu H, Deng X, Cheng X, Li Y, Chen W, Zhang Y. Risk factors analysis and nomogram construction for blood transfusion in elderly patients with femoral neck fractures undergoing hemiarthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:1637-1645. [PMID: 35166874 DOI: 10.1007/s00264-022-05347-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Elderly patients with femoral neck fractures (FNFs) undergoing hemiarthroplasty usually have poor physical condition. The main aim of this study was to identify risk factors for blood transfusion in these patients and construct a nomogram to intuitively predict the requirement of transfusion. The secondary purpose was to examine the relationship between blood transfusion and complications within 30 days post-operatively. Our hypothesis was that chronic kidney disease (CKD) and hypoalbuminemia may increase the requirement of transfusion. METHODS Data of 414 elderly patients undergoing hemiarthroplasty for FNFs were retrospectively collected. Univariate and multiple regression analysis were performed to identify independent risk factors for blood transfusion, which were used to construct a nomogram subsequently. The discrimination and calibration of the nomogram model were assessed with concordance index (C-index), the area under receiver operating characteristic curve (AUC), and calibration curve. Furthermore, the complications of blood transfusion within 30 days post-operatively were also analyzed. RESULTS Out of 414 patients, 127 (30.7%) received a blood transfusion. Independent risk factors for blood transfusion included CKD, hypoalbuminemia, pre-operative anaemia, general anaesthesia, higher American Society of Anesthesiologists score, more intraoperative blood loss, and longer surgical time. Increased hidden blood loss, deep vein thrombosis, superficial wound infection, and prolonged hospital stays were more common in transfused patients. The C-index of the nomogram model was 0.848 (95% CI = 0.811-0.885), and the AUC value was 0.859. The calibration curve showed a good consistency between the actual transfusion and the predicted probability. DISCUSSION We observed a transfusion rate of 30.7% in elderly FNF patients undergoing hemiarthroplasty. CKD and hypoalbuminemia were firstly identified as independent risk for blood transfusion. In addition, blood transfusion can increase the occurrence of early post-operative complications. CONCLUSION Targeted pre-operative intervention, such as optimizing CKD and correcting hypoalbuminemia is essential and highly regarded.
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Affiliation(s)
- Jian Zhu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, China.,School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongzhi Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaodong Cheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yonglong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China. .,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China.
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15
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Yue R, Yang M, Deng X, Zhang P. Allogeneic Red Blood Cell Transfusion Rate and Risk Factors After Hemiarthroplasty in Elderly Patients With Femoral Neck Fracture. Front Physiol 2021; 12:701467. [PMID: 34393821 PMCID: PMC8358805 DOI: 10.3389/fphys.2021.701467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 01/28/2023] Open
Abstract
Objective This study aimed to determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) after hemiarthroplasty (HA) in elderly patients with femoral neck fracture (FNF). Methods The subjects of the study were elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital between March 2018 and June 2019 for HA treatment due to an FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analyses were performed to determine the post-operative ABT rate and its risk factors. Results There were 445 patients in the study, of whom 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and a low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion ABT after HA is a common phenomenon in elderly patients with FNF. Their post-operative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced by taking these factors into account. When the same patient had three risk factors (preoperative low hemoglobin, advanced age, and low BMI), the risk of ABT was very high (78.3%). Also, when patients have two risk factors of preoperative low hemoglobin and low BMI, the risk of ABT was also high (80.0%).
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Affiliation(s)
- Rui Yue
- Department of Cadre Health Care, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaohui Deng
- Department of Cadre Health Care, Beijing Jishuitan Hospital, Beijing, China
| | - Ping Zhang
- Department of Cadre Health Care, Beijing Jishuitan Hospital, Beijing, China
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16
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Ngarmukos S, Kim KI, Wongsak S, Chotanaphuti T, Inaba Y, Chen CF, Liu D. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors. Knee Surg Relat Res 2021; 33:18. [PMID: 34147134 PMCID: PMC8214263 DOI: 10.1186/s43019-021-00099-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Srihatach Ngarmukos
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu Seoul, Seoul, 134-727, Korea. .,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Siwadol Wongsak
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanainit Chotanaphuti
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David Liu
- Gold Coast Centre for Bone & Joint Surgery, Gold Coast, Australia
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17
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Mukiibi W, Maharaj Z, Sekeitto AR, Mokete L, Pietrzak JRT. The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital. SICOT J 2021; 7:34. [PMID: 34009118 PMCID: PMC8132601 DOI: 10.1051/sicotj/2021023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Femoral neck fractures (FNFs) remain "the unsolved fracture" and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. METHODS We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. RESULTS There were 117 patients (33 male/84 female) 72 years (33-97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8-20) and was 18.95 (11-20) for THA patients compared to 14.46 (8-20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8-19 days (1-22) and 7-61 days (2-31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). CONCLUSION The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended. Retrospective Study, Level III evidence.
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Affiliation(s)
- Winifred Mukiibi
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Zia Maharaj
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Allan Roy Sekeitto
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Lipalo Mokete
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Jurek Rafal Tomasz Pietrzak
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
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18
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Preoperative Platelet and International Normalized Ratio Thresholds and Risk of Complications After Primary Hip Fracture Surgery. J Am Acad Orthop Surg 2021; 29:e396-e403. [PMID: 32796366 DOI: 10.5435/jaaos-d-19-00793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 07/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A paucity of data exists on safe platelet and international normalized ratio (INR) thresholds for hip fracture surgery. Recent work has called into question the safety of preoperative INRs < 1.5 for total knee arthroplasty, and optimal platelet thresholds are unknown. The purpose of this study was to identify the risk of 30-day postoperative morbidity and mortality in patients with thrombocytopenia or elevated INRs undergoing hip fracture surgery. METHODS The National Surgical Quality Improvement Program database was queried for patients undergoing surgical treatment of a native hip fracture from 2012 to 2017 (N = 86,850). Patient demographic, laboratory, and complication data were collected. Patients with preoperative platelet counts or INRs within one day of surgery were included for analysis. Preoperative platelet counts and INRs were divided into four groups (<50 k/μL, ≥50 k to 100 k/μL, ≥100 k to 150 k/μL, ≥150 k/μL, and ≤1.0, >1.0 to 1.5, >1.5 to 2.0, and >2.0, respectively). Multivariable logistic regressions were used to assess the independent association between platelet count and INR on bleeding complications requiring transfusion, wound complications, reoperations, readmissions, and deaths. RESULTS A total of 72,306 and 56,027 patients were included for analysis of preoperative platelet and INR levels, respectively. In reference to platelet levels ≥150 k/μL, a notably increased risk of bleeding events was observed for patients with platelet counts ≥100 k to 150 k/μL (odds ratio [OR] 1.21, 95% confidence interval 1.15 to 1.27), ≥50 to 100 k/μL (OR 1.85, 1.69 to 2.03), and <50 k/μL (OR 1.60, 1.25 to 2.04). Decreasing platelet counts were associated with a stepwise increased risk of mortality from OR 1.12 (1.02 to 1.22) for platelet counts ≥100 k to 150 k/μL to OR 1.63 (1.41 to 1.90) and OR 1.59 (1.06 to 2.39) for platelet counts ≥50 k to 100 k/μL and <50 k/μL, respectively. Elevated INR was associated with an increased risk of reoperations, readmissions, and death (P < 0.001 for all), with largest effect sizes observed starting at INRs >1.5. DISCUSSION The results of this study suggest that preoperative platelet thresholds of <100,000/μL and INR thresholds of 1.5 serve as an important risk factor for complications after hip fracture surgery. Future work is warranted to determine whether preoperative platelet transfusions and/or INR reversal will improve outcomes for these patients. LEVEL OF EVIDENCE Prognostic Level III.
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19
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Li X, Luo J. Hemiarthroplasty compared to total hip arthroplasty for the treatment of femoral neck fractures: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:172. [PMID: 33658055 PMCID: PMC7931515 DOI: 10.1186/s13018-020-02186-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/25/2020] [Indexed: 01/11/2023] Open
Abstract
Background Hip replacement is divided into total hip arthroplasty (THA) and hemiarthroplasty (HA); it is still controversial whether to choose THA or HA for femoral neck fractures (FNF). The goal of this study was to review relevant studies in order to determine the HA compared to THA for the treatment of FNF. Patients and methods Using appropriate keywords, we identified relevant studies using PubMed, Cochrane, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through August 2019 were considered for inclusion. For each study, we assessed odds ratios (ORs), mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. Results We included 19 studies with a total of 413,140 patients in the HA group and 44973 in the THA group. The blood loss, surgery time, and dislocation were all significantly decreased in the HA group than the THA group. The length of hospital, pneumonia, and renal failure were significant increased in the HA group than THA group. There has no significant difference of complication, mortality, reoperation, infection, pulmonary embolism, and myocardial infarct between the two groups. Conclusion HA has favor in decrease blood loss and surgery time. THA has favor in decrease the length of hospital, the incidence of pneumonia and renal failure. For the selection of surgical methods for femoral neck fracture in the elderly, we should consider several aspects, such as the age of the patient, whether there is osteoporosis, the type of femoral neck fracture, the preoperative reduction situation, and the needs of the patient and his family for the postoperative situation. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-020-02186-4.
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Affiliation(s)
- Xinbo Li
- Trauma Orthopedics Ward 1, Ningbo No. 6 Hospital, No. 1059, Zhongshan East Road, Dongliu Street, Yinzhou District, Ningbo City, 315040, Zhejiang Province, China
| | - Jianning Luo
- Trauma Orthopedics Ward 2, Ningbo No. 6 Hospital, No. 1059, Zhongshan East Road, Dongliu Street, Yinzhou District, Ningbo City, 315040, Zhejiang Province, China.
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Sekeitto AR, Sikhauli N, van der Jagt DR, Mokete L, Pietrzak JR. The management of displaced femoral neck fractures: a narrative review. EFORT Open Rev 2021; 6:139-144. [PMID: 33828857 PMCID: PMC8022011 DOI: 10.1302/2058-5241.6.200036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This article serves to review the existing clinical guidelines, and highlight the most recent medical and surgical recommendations, for the management of displaced femoral neck fractures (FNFs). It stresses the need for multi-disciplinary intervention to potentially improve mortality rates, limit adverse events and prevent further economic liability.Globally, the incidence of FNFs continues to rise as the general population ages and becomes more active. The annual number of FNFs is expected to exceed six million by 2050. The increased burden of FNFs exacerbates the demand on all services associated with treating these injuries.The management of FNFs may serve as an indicator of the quality of care of the geriatric population. However, despite escalating health costs, a significant 30-day and one-year mortality rate, increased rate of peri-operative adverse events and sub-optimal functional clinical outcomes, continued controversy exists over optimal patient care.Much debate exists over the type of surgery, implant selection and peri-operative clinical care and rehabilitation. FNF care models, systematized clinical pathways, formal geriatrics consultation and specialized wards within an established interdisciplinary care framework may improve outcomes, mitigate adverse events and limit unnecessary costs. Cite this article: EFORT Open Rev 2021;6:139-144. DOI: 10.1302/2058-5241.6.200036.
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Affiliation(s)
- Allan Roy Sekeitto
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkhodiseni Sikhauli
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Dick Ronald van der Jagt
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Lipalo Mokete
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jurek R.T. Pietrzak
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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21
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Haynes MS, Ondeck NT, Ottesen TD, Malpani R, Rubin LE, Grauer JN. Perioperative Outcomes of Hemiarthroplasty Versus Total Hip Arthroplasty for Geriatric Hip Fracture: The Importance of Studying Matched Populations. J Arthroplasty 2020; 35:3188-3194. [PMID: 32654940 DOI: 10.1016/j.arth.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Geriatric femoral neck fracture is a common injury for which hemiarthroplasty (HA) or total hip arthroplasty (THA) may be considered in select patients. As prior database studies comparing these have not used propensity matching, which is a robust statistical method of controlling for potentially confounding variables, unmatched and matched methodologies are contrasted in the present study. METHODS Patients aged ≥70 years who underwent HA or THA for hip fractures were identified from the 2012-2015 National Surgical Quality Improvement database. Propensity score 1:1 matching was performed. Differences in rates of 30-day postoperative adverse outcomes were compared using multivariate logistic regression for unmatched and matched cohorts. RESULTS In total, 15,558 patients (14,403 HA and 1155 THA) were evaluated. Although multivariate outcomes for the unmatched populations were different for blood transfusion, mortality, minor adverse events, major adverse events, and reoperation, multivariate outcomes for matched populations only differed for blood transfusion (odds ratio 0.6 for HA vs THA, P < .001). Of note, although readmissions were similar for the two groups, patients undergoing THA had a 5.4% greater rate of perioperative readmission due to dislocation. CONCLUSION Geriatric patients undergoing HA and THA for hip fracture were compared with and without propensity matching. Once matching was performed, the only differences in outcomes between the two groups were a lower transfusion rate among the HA group and a greater readmission rate due to dislocation among the THA group. This suggests that either procedure can be safely considered if found to be advantageous from a longer-term outcome perspective. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Monique S Haynes
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Nathaniel T Ondeck
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Taylor D Ottesen
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Rohil Malpani
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Lee E Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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22
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Association between Hemiarthroplasty vs Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture. J Clin Med 2020; 9:jcm9103203. [PMID: 33023020 PMCID: PMC7601407 DOI: 10.3390/jcm9103203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95% Confidence interval (CI), 2.21–3.27; p < 0.001; RD, 2.82; 95% CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.
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Sircana G, Cauteruccio M, Oliva MS, Piccirillo N, Pesare E, Minutillo F, Ziranu A. Fibrin sealant reduces need for transfusions after hip hemiarthroplasty for femoral neck fractures. Injury 2020; 51 Suppl 3:S23-S27. [PMID: 32564965 DOI: 10.1016/j.injury.2020.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Every year more than 300,000 proximal femur fractures are diagnosed. Their number will double within 30 years. In femoral neck fractures treated with hip hemiarthroplasty 90-days mortality is 29.5-51.6%. Haemorrhage is one amongst other complications that is associated with increasing postoperative mortality. Transfusion rate in these patients ranges from 25.7% to 39%. Blood transfusions expose to complications. Fibrin sealants are useful in reducing perioperative need for transfusions, total blood loss, blood loss from drainage. The aim of this study is to assess whether the use of a fibrin sealant during hip hemiarthroplasty implant reduces the need for transfusion. PATIENT AND METHODS All patients admitted with a proximal femur fracture from September 2018 to May 2019 were reviewed. Inclusion criteria were: femoral neck fracture AO 31B2-3, hip hemiarthroplasty. Exclusion criteria were: previous surgery on the affected hip, coagulation disorders, hematopoietic disorders. Patients were divided in fibrin sealant group and control group. All patients underwent partial hip replacement through a posterolateral approach. 4 ml of fibrin sealant (EVICEL, Omrix Biopharmaceuticals, Diegem, Belgium) were sprayed on the soft tissues of patients included in the fibrin sealant group. Primary outcome of our study was need for perioperative transfusion. Secondary outcomes were: mean red blood cell transfused volume, variations in haematocrit and haemoglobin and total blood volume loss. RESULTS Eighty-one consecutive patients were enrolled. EVICEL was used on 19 patients, standard haemostatic care on 62 patients. Two patients were transfused in the fibrin sealant group, 22 in the control group (p 0,0371). Mean transfused volume was 21,05 ml in the fibrin sealant group and 116,16 ml in the control group (p 0,0017). No significant difference could be found in haematocrit and haemoglobin variation and total blood loss. DISCUSSION A reduction in transfusional need with the use of fibrin sealants was reported in studies on total hip arthroplasty and was confirmed by our study. CONCLUSION EVICEL reduces need for transfusion in patients undergoing hip hemiarthroplasty for a femoral neck fracture. It must be held among the options when a stricter control on transfusional requirement is needed.
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Affiliation(s)
- Giuseppe Sircana
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Michele Cauteruccio
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Maria Serena Oliva
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
| | - Nicola Piccirillo
- UOC Emotrasfusione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Elisa Pesare
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Felice Minutillo
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Antonio Ziranu
- UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
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Xiao P, Zhou Y. Factors associated with the burden of family caregivers of elderly patients with femoral neck fracture: a cross-sectional study. J Orthop Surg Res 2020; 15:234. [PMID: 32576212 PMCID: PMC7310331 DOI: 10.1186/s13018-020-01749-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/16/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study aimed to study the factors associated with caregiver burden among caregivers of elderly patients with femoral neck fracture. METHODS This cross-sectional study was based on a non-probabilistic sampling of 183 elderly postoperative patients (aged 65 years or older) with femoral neck fracture who were hospitalized in the orthopedic center in our hospital and their family caregivers. Data were collected from January 2016 to June 2019. Patients and family caregivers completed the sociodemographic questionnaire. The Social Support Rating Scale (SSRS), the General Self-Efficacy Scale (GSE), and the Chinese version of the Zarit Burden Interview (ZBI) were used to evaluate social support, self-efficacy, and caregiver burden, respectively. By analyzing the clinical data of patients and family caregivers and combining the factors that affect the caregiver burden in parallel studies, we selected the factors that affected the caregiver burden in this study and conducted a multivariate analysis of these factors. P < 0.05 was considered statistically significant. RESULTS We observed 176 caregivers aged 69.28 ± 7.19 years old, among whom 52.3% were male, 58.0% lived in the city, 84.0% were spouses of the patients, and 67.0% had a primary school educational background. The ZBI score of the family caregivers was 37.8 ± 8.9, and 82.7% of the caregivers were under a moderate to severe burden. The patient's functional status, Harris score, and pain score and the caregiver's SSRS scores, GSE scores, and the ratio of medical expenses to monthly income per capita were factors that affected the caregiver burden. CONCLUSIONS Most family caregivers of elderly patients with femoral neck fracture are subject to a considerable care burden, and social support and self-efficacy intervention are conducive to reducing the caregiver burden.
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Affiliation(s)
- Peifen Xiao
- Department of Orthopedics, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi People’s Republic of China
| | - Yongchun Zhou
- Department of Orthopedics, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi People’s Republic of China
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25
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Suarez JC, Arguelles W, Saxena A, Rivera P, Parris D, Veledar E. Hemiarthroplasty vs Total Hip Arthroplasty for Femoral Neck Fractures: 2010-2017 Trends in Complication Rates. J Arthroplasty 2020; 35:S262-S267. [PMID: 32222266 DOI: 10.1016/j.arth.2020.02.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Optimal treatment of femoral neck fractures (FNFs) remains debated. Recent data suggest that total hip arthroplasty (THA) confers improved functional outcomes compared to hemiarthroplasty (HA) in active patients. However, temporal trends in complication rates between these treatments lack study. METHODS The National Surgical Quality Improvement Program database was retrospectively queried to compare differences between HA and THA over time (2010-2012, 2013-2015, and 2016-2017) in blood transfusions, operation time, major complications, minor complications, and 30-day readmission, among FNF patients aged ≥50 years. Analyses adjusted for age, gender, anesthesia type, smoking, body mass index, hypertension, bleeding disorder, steroid use, and American Society of Anesthesiologists classification. RESULTS In total, 16,213 patients were identified. THA was associated with higher transfusion rates in 2010-2012 (mean = 0.34 vs 0.28, P = .001) and 2013-2015 (mean = 0.21 vs 0.19, P = .002), but not in 2016-2017 (mean = 0.13 vs 0.14, P = .146). Operation time was significantly higher for THA across all periods (P's < .001), but declined over time. In recent years, THA was associated with less major (2016-2017: 5.4% vs 10.2%, P = .02; 2013-2015: 5.3% vs 10.3%, P < .001) and minor (2016-2017: 6.2% vs 9.8%, P = .02; 2013-2015: 7.2% vs 12.4%, P < .001) complications compared to 2010-2012 (major: 7.2% vs 10.6%, P = .87; minor: 12.6% vs 10.1%, P = .89). No differences in 30-day readmission were noted. CONCLUSION THA was associated with less major and minor complications in recent time periods compared to HA for the treatment of FNF, controlling for comorbidities. THA trends in transfusions and operation duration have improved over time compared to HA.
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Affiliation(s)
- Juan C Suarez
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL
| | - William Arguelles
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Priscilla Rivera
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Don Parris
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Emir Veledar
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
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26
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Could a Simple Screening Procedure Identify Patients With Early Cognitive Impairment? Implications for the Treatment of Geriatric Femoral Neck Fractures. J Arthroplasty 2020; 35:1023-1028. [PMID: 31859012 DOI: 10.1016/j.arth.2019.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Current evidence suggests that cognitive capacities in patients who sustain a femoral neck fracture (FNF) correlate to patient outcome. We hypothesized that a simple selection procedure with 2 questions: "Can you perform your groceries independently?" and "Can you prepare your daily medications unassisted?", which imply a certain level of physical and cognitive function, could identify patients with early cognitive impairment and as a result influence the outcome of hip arthroplasty following an FNF. METHODS At our clinic, the selection procedure was introduced in 2012 to simplify decision-making in geriatric FNF. At the time of surgery, patients received a total hip arthroplasty (THA) when able to perform their grocery shopping and prepare their daily medications unassisted (n = 100); otherwise, a hemiarthroplasty (HA) was performed (n = 100). Postoperative complications and mortality were assessed retrospectively. Second, we prospectively investigated whether patients' inability to perform groceries or prepare medications was associated with the presence of early cognitive impairment, tested with the Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery. RESULTS The screening questions showed almost perfect agreement (k = 0.8; sensitivity/specificity: 82%/95%) to early cognitive impairment. The 30-day mortality for THA and HA patients was 2% and 4%, respectively. The 1-year and 5-year survivorship for the THA group was 95% and 87% and for the HA group 63% and 8%, respectively. Complication rates were comparable. CONCLUSION The results might suggest that 2 simple screening questions could help in the decision-making of the appropriate surgical treatment in elderly patients suffering from a displaced FNF.
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Wang JQ, Chen LY, Jiang BJ, Zhao YM. Development of a Nomogram for Predicting Blood Transfusion Risk After Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients. Med Sci Monit 2020; 26:e920255. [PMID: 32074099 PMCID: PMC7043352 DOI: 10.12659/msm.920255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs). Material/Methods We performed a retrospective study including consecutive elderly FNF patients treated by HA between January 2015 and December 2017. Perioperative information was obtained retrospectively, uni- and multivariate regression analyses were conducted to determine risk factors for blood transfusion, and a nomogram model was constructed to predict the risk of blood transfusion. The predictive performance and consistency of the model were evaluated by the consistency coefficient (C-index) and the calibration curve, respectively. Results Of 178 patients, 151 were finally enrolled in the study and 21 received blood transfusion. Binary logistic regression analysis showed the low preoperative hemoglobin (Hb), longer time to surgery, general anesthesia, longer surgery duration, and higher intraoperative blood loss (IBL) were risk factors for blood transfusion. The accuracy of the contour map for predicting transfusion risk was 0.940. Conclusions We found a correlation between blood transfusion requirement and low preoperative Hb, longer time to surgery, general anesthesia, longer surgery duration, and higher IBL, and we then developed a nomogram. Our nomogram model can be used to evaluate the transfusion risk for FNF patients after HA, and provides better guidance for clinicians to intervene perioperatively, so as to reduce the incidence of blood transfusion.
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Affiliation(s)
- Ji-Qi Wang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Lu-Ying Chen
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Bing-Jie Jiang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - You-Ming Zhao
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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28
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Agarwalla A, Liu JN, Gowd AK, Amin NH, Werner BC. Differential Use of Narcotics in Total Hip Arthroplasty: A Comparative Matched Analysis Between Osteoarthritis and Femoral Neck Fracture. J Arthroplasty 2020; 35:471-476. [PMID: 31564525 DOI: 10.1016/j.arth.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The United States is currently in an opioid epidemic as it consumes the majority of narcotic medications. The purpose of this investigation is to identify the incidence and risk factors for prolonged opioid usage following total hip arthroplasty (THA) due to hip fracture (Fx) or osteoarthritis (OA). METHODS The PearlDiver database was reviewed for patients undergoing THA from 2007 through the first quarter of 2017. Following a 3:1 match based on comorbidities and demographics, patients were divided into THA due to Fx (n = 1801) or OA (n = 5403). Preoperative and prolonged postoperative narcotic users were identified. Multivariate logistic regression analysis was performed to identify demographics, comorbidities, or diagnoses as risk factors for prolonged opioid use and preoperative and postoperative opioid use as risk factors for complications. RESULTS One thousand seven hundred ninety-four OA patients (33.2%) were prescribed narcotics preoperatively and 1655 patients (30.6%) were using narcotics postoperatively, while 418 Fx patients (23.2%) were prescribed narcotics preoperatively and 499 patients (27.7%) were using narcotics postoperatively. Diagnosis of Fx (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.28-1.72, P < .001) and preoperative narcotic use (OR 6.12, 95% CI 5.27-6.82, P < .001) were the most significant risk factors for prolonged postoperative narcotic use. Prolonged postoperative narcotic use was associated with increased infection, dislocation, and revision THA in both Fx and OA groups. CONCLUSION Diagnosis of femoral neck fracture and overall preoperative narcotic use were significant predictors of chronic postoperative opioid use. Patients with significant risk factors for opioid dependence should receive additional consultation and more prudent follow-up with regards to pain management. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
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29
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Neyisci C, Erdem Y, Bilekli AB, Bek D. Direct Anterior Approach Versus Posterolateral Approach for Hemiarthroplasty in the Treatment of Displaced Femoral Neck Fractures in Geriatric Patients. Med Sci Monit 2020; 26:e919993. [PMID: 31961830 PMCID: PMC6993556 DOI: 10.12659/msm.919993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background In the present study, we aimed to evaluate early clinical and biochemical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for hemiarthroplasty in the treatment of displaced femoral neck fractures in geriatric patients. Material/Methods Between September 2012 and September 2017, a total of 110 patients who underwent hemiarthroplasty for displaced femoral neck fractures were retrospectively analyzed. The patients were divided into 2 groups according to the surgical technique PLA (Group 1, n=54) and DAA (Group 2, n=56). Clinical and biochemical results were compared. Results There was no significant difference in the demographic characteristics of the patients, fixation type, and follow-up (P>0.05). However, there was a significant difference in the duration of surgery, amount of blood transfusion, change from baseline in postoperative hemoglobin levels, amount of intraoperative gauze dressing, amount of drainage fluid from the surgical wound, postoperative VAS scores, incision length, length of hospital stay, and Barthel Index scores in favor of DAA group (P<0.05). There was no significant difference in the degree of mobilization (P>0.05). None of the patients had postoperative complications in Group 1, while 3 patients in Group 2 developed a lateral femoral cutaneous nerve lesion and one patient had a missed iatrogenic fracture of the greater trochanter. Conclusions Our study results suggest that early clinical and biochemical outcomes are better in DAA than PLA with early return to daily living activities in patients undergoing hemiarthroplasty for displaced femoral neck fractures.
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Affiliation(s)
- Cagri Neyisci
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Erdem
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ahmet Burak Bilekli
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Dogan Bek
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
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Tsai MC, Ng YY, Chen WM, Tsai SW, Wu SC. The effects of cement fixation on survival in elderly patients with hip hemiarthroplasty: a nationwide cohort study. BMC Musculoskelet Disord 2019; 20:628. [PMID: 31881878 PMCID: PMC6935190 DOI: 10.1186/s12891-019-3013-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. METHODS Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. RESULTS The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative mortality was significantly stronger within 7 days than within 30, 180 days and 1 year. In addition, the male gender, age > 85 years and higher score on the Charlson Comorbidity Index were also risk factors for mortality (p < 0.05). Patients who received HHA in lower-volume hospitals had higher mortality rates within 180 days and 1 year than those in higher-volume hospitals. Compared with patients who were operated on by high-volume surgeons, those who received surgery performed by lower-volume surgeons were more likely to die within 30 days (aHR = 1.22), 180 days (aHR = 1.16) and 1 year (aHR = 1.19), respectively. CONCLUSIONS The postoperative mortality rate of elderly patients undergoing HHA was significantly higher in the cemented group than in the non-cemented group.
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Affiliation(s)
- Ming-Che Tsai
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yee-Yung Ng
- Department of Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan, Republic of China.
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Hansson S, Bülow E, Garland A, Kärrholm J, Rogmark C. More hip complications after total hip arthroplasty than after hemi-arthroplasty as hip fracture treatment: analysis of 5,815 matched pairs in the Swedish Hip Arthroplasty Register. Acta Orthop 2019; 91:133-138. [PMID: 31735103 PMCID: PMC7144190 DOI: 10.1080/17453674.2019.1690339] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Total hip arthroplasty (THA) is increasing as treatment of displaced femoral neck fractures. Several studies compare hemiarthroplasty (HA) with THA, but results vary and few studies report on medical complications. We examined the outcome of THA and HA with a focus on medical complications, hip complications, and death.Patients and methods - Data from the Swedish Hip Arthroplasty Register on 30,953 acute hip fracture patients treated with cemented THA or HA in 2005-2011 were cross-matched with Statistics Sweden for socioeconomic data and with the National Patient Register for diagnostic codes representing medical complications within 180 days or hip complications within the study period. Propensity score matching was used to create comparable groups based on age, sex, income, level of education, marital status, Elixhauser index, and year of surgery. Logistic regression models were created for each outcome.Results - 81% were treated with HA, 73% and 71% were female (HA and THA respectively). Matching resulted in 2 groups of 5,815 patients each. THA was associated with fewer medical complications (OR = 0.83; 95% CI 0.76-0.91) and lower 1-year mortality (OR = 0.42; CI 0.38-0.48), but more hip complications (OR = 1.31; CI 1.20-1.43).Interpretation - THA as treatment of hip fracture was associated with more hip-related complications than HA. The results on mortality and medical complications are, rather, influenced by residual confounding than by the implant design per se. An expansive use of THAs for hip fracture treatment, at the expense of HAs, is not recommended based on our findings if hip complications are to be avoided.
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Affiliation(s)
- Susanne Hansson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö;
| | - Erik Bülow
- The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anne Garland
- Department of Orthopaedics, Visby Hospital, Visby; ,Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University, Uppsala;
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö; ,The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg; ,Correspondence:
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Varady NH, Ameen BT, Hayden BL, Yeung CM, Schwab PE, Chen AF. Short-Term Morbidity and Mortality After Hemiarthroplasty and Total Hip Arthroplasty for Pathologic Proximal Femur Fractures. J Arthroplasty 2019; 34:2698-2703. [PMID: 31279601 DOI: 10.1016/j.arth.2019.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/29/2019] [Accepted: 06/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As oncology patients have increasing life expectancies, total hip arthroplasty (THA) may become an important treatment option for pathologic proximal femur fractures (PPFFs). Although THA and hemiarthroplasty (HA) have been compared for native hip fracture treatment, no data on short-term morbidity and mortality are available in the pathologic setting. The purpose of this study is to compare short-term morbidity and mortality of HA vs THA for PPFFs. METHODS The National Surgical Quality Improvement Program database was queried from 2007 to 2017 for patients with PPFFs treated with HA or THA. Propensity-adjusted logistic regressions were implemented to compare 30-day morbidity and mortality between procedures. Backwards stepwise regression was then used to determine independent predictors of treatment with HA compared to THA. RESULTS In adjusted analysis, THA was associated with longer operative times (120.3 ± 5.6 vs 98.7 ± 4.9 minutes, P < .001); however, there were no differences between THA and HA with regard to 30-day rates of major complications (P = .3), minor complications (P = .77), reoperations (P = .99), readmissions (P = .35), or deaths (P = .63). Older age (P < .001), dependent functional status (P = .02), and the presence of disseminated cancer (P = .049) were predictive of undergoing HA compared to THA. CONCLUSION As patients with metastatic cancer continue to live longer with their disease, the durability of surgical reconstruction to treat PPFFs is becoming increasingly important. This study demonstrated no significant differences in 30-day complications between PPFF patients treated with THA or HA after controlling for underlying confounders. These results suggest that THA can be utilized to treat certain patients with PPFFs, and future work is warranted to examine long-term functional outcomes.
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Affiliation(s)
- Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bishoy T Ameen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Caleb M Yeung
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pierre-Emmanuel Schwab
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Eskildsen SM, Kamath GV, Del Gaizo DJ. Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients. Hip Int 2019; 29:674-679. [PMID: 30526123 DOI: 10.1177/1120700018816924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. METHODS This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. RESULTS We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates (p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592-0.678), dislocation 1.76% versus 3.39% (0.512; 0.476-0.551), infection 3.44% versus 4.87% (0.694; 0.657-0.737). There was no statistical significant difference in 2-year cardiac morbidity (p = 0.252). However, when controlling for age, patients 65-69 years showed no significant difference in infection or revision over the study period or at 2 years. CONCLUSIONS In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65-69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.
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Affiliation(s)
- Scott M Eskildsen
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Ganesh V Kamath
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel J Del Gaizo
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
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Warren JA, Sundaram K, Anis HK, Piuzzi NS, Higuera CA, Kamath AF. Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes. Geriatr Orthop Surg Rehabil 2019; 10:2151459319876854. [PMID: 31565492 PMCID: PMC6755631 DOI: 10.1177/2151459319876854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/22/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction: Displaced femoral neck fractures in the elderly individuals may be treated with total
hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the
short-term medical outcomes are related to these surgical options. The purpose of this
study was to compare early postoperative outcomes in THA patients to those of HHA
patients. Methods: In this study, we compared 30-day mortality, likelihood of still being in the hospital
at 30 days, postoperative major and minor complications, discharge disposition,
reoperation and readmission, length of stay, days from admission to surgery, and
operative time between THA and HHA. Using the American College of Surgeons National
Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from
2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and
2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate
regression models were created. Results: The THA patients ≥65 years old were at reduced risk for mortality (P =
.029) and still being in the hospital at 30 days (P = .017). The THA
patients were at an increased risk for minor complications (P = .011)
and longer operative times (P < .001). However, THA patients were
more likely to have a home discharge (P < .001). Discussion: Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality
risk, were more likely to be discharged home, and had less likelihood of being in the
hospital at 30 days. This is the first study to explore short-term outcomes in patients
≥65 and has direct implications for alternate payment and merit-based payment
models. Conclusion: As hip fracture treatment has come under scrutiny with respect to alternate payment
models and merit-based incentive payments, this analysis of short-term outcomes warrants
consideration when evaluating treatment pathways.
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Affiliation(s)
- Jared A Warren
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kavin Sundaram
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
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Flury A, Finsterwald M, Dimitriou D, Helmy N, Hasler J, Antoniadis A. Should advanced age be a contraindication to total hip arthroplasty in femoral neck fracture patients? A matched-control, retrospective study. J Orthop 2019; 17:25-29. [PMID: 31879469 DOI: 10.1016/j.jor.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction Due to demographic changes, the annual incidence of femoral neck fractures (FNF) in patients reaching the 9th and 10th decade of life is increasing. Although active and cognitively intact elderly patients could benefit from total hip arthroplasty (THA) in case of a FNF, there is no clear consensus on whether THA should be performed in this particular subgroup of patients with very advanced age. The purpose of this study was to report the complication rate, mortality, clinical outcomes and quality-adjusted life year (QALY) gained in patients treated with total THA for FNF, while having exceeded the mean life expectancy at the time of surgery, compared to a younger control group. Materials and Methods Patients treated with THA through a direct anterior approach (DAA) for FNF and exceeding the average life expectancy in Switzerland (age ≥ 83 y, n = 45) were matched for gender, body mass index (BMI) and ASA score with patients under the age of 83 (age = 65-83, n = 45). Perioperative complications, clinical and radiologic outcomes, as well as mortality were compared between groups. Results Total complication rate did not differ significantly with 22.2% in the older group compared to 17.8% in the control group. The 30-day and 1-year mortality was slightly but not significantly higher in the older group (2.2% and 8.9% vs. 2.2% and 2.2%). The average QALY gained was 3.4 years and 4.1 years for the older group and their younger counterparts, respectively. Conclusion THA through the DAA for FNF in cognitively intact and active patients might be a credible and safe option even after reaching mean life expectancy with excellent functional outcomes and similar surgery-related complications compared to patients younger than 83 years. Our results imply that an advanced age should not be considered a contraindication for THA in case of a FNF.
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Affiliation(s)
- Andreas Flury
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Julian Hasler
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Alexander Antoniadis
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
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Xie J, Hu Q, Huang Q, Chen G, Zhou Z, Pei F. Efficacy and safety of tranexamic acid in geriatric hip fracture with hemiarthroplasty: a retrospective cohort study. BMC Musculoskelet Disord 2019; 20:304. [PMID: 31248398 PMCID: PMC6598293 DOI: 10.1186/s12891-019-2670-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 06/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Geriatric hip fracture patients are particularly susceptible to blood loss and venous thromboembolism (VTE) during hemiarthroplasty, yet relatively few studies have examined the safety and efficacy of tranexamic acid (TXA) in these patients. METHODS This cohort study of hip fracture patients (≥65 years) undergoing hemiarthroplasty between January 2013 and September 2016 involved 289 patients who received 15 mg/kg TXA prior to surgery and 320 who received no TXA. All patients underwent a fast-track program including nutrition, blood, and pain management; VTE prophylaxis; early mobilization; and early intake. The primary outcome was red cell transfusion requirement. Secondary outcomes included blood loss, hemoglobin (Hb) level, VTE, adverse events and length of hospital stay. Multivariate logistic regression and meta-analysis of the literature were also performed to control for confounding factors and identify risk factors of red cell transfusion. RESULTS The proportion of patients receiving at least 1 U of erythrocytes was significantly lower in the TXA group (8.65%) than in the control group (24.06%, OR 0.299, p < 0.001). Mean Hb level was significantly higher in the TXA group on postoperative day 1 (111.70 ± 18.40 vs 107.29 ± 18.70 g/L, p = 0.008) and postoperative day 3 (108.16 ± 17.25 vs 104.22 ± 15.16 g/L, p = 0.005). A significantly higher proportion of TXA patients began to ambulate within 24 h after surgery (37.02% vs 26.25%, p = 0.004), and their length of hospitalization was significantly shorter (11.82 ± 4.39 vs 15.96 ± 7.30 days, p = 0.003). TXA did not increase risk of DVT (OR 0.70, 95%CI 0.25 to 1.97). Logistic regression showed that, after adjusting for covariates, TXA was associated with 62% lower risk of red blood cell transfusion (0.327, 95%CI 0.214 to 0.696), and a similar result was obtained in meta-analysis of unadjusted data from the present study and the literature (OR 0.33, 95%CI 0.25 to 0.43). CONCLUSION TXA appears to be safe and effective for reducing blood loss and red blood cell transfusion in geriatric hip fracture patients undergoing fast-track hemiarthroplasty.
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Affiliation(s)
- Jinwei Xie
- Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Qinsheng Hu
- Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Qiang Huang
- Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Guo Chen
- Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
| | - Fuxing Pei
- Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Kwak DK, Jang CY, Kim DH, Rhyu SH, Hwang JH, Yoo JH. Topical tranexamic acid in elderly patients with femoral neck fractures treated with hemiarthroplasty: efficacy and safety? - a case-control study. BMC Musculoskelet Disord 2019; 20:228. [PMID: 31101040 PMCID: PMC6525434 DOI: 10.1186/s12891-019-2615-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative blood management is an important issue in the treatment of elderly patients at an increased risk of postoperative complications. Accordingly, tranexamic acid (TXA) is widely administered to reduce blood loss and transfusion requirements. In this case-control study, the effect of topical TXA on the outcomes of elderly patients with femoral neck fractures after hemiarthroplasty was evaluated. Methods This study enrolled elderly patients (age ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fractures between January 2015 and January 2017. The study group comprised 72 patients who received TXA via topical administration during surgery. After propensity matching, the control group comprised 72 patients who did not receive topical TXA. The perioperative and postoperative parameters of the two groups were compared. Results The estimated blood loss, vacuum tube drainage, and total transfusion volume were significantly lower in the study group than the control (p = 0.024, 0.003, and 0.019, respectively). Despite a lack of significant intergroup differences in the lengths of ICU and hospital stays; rates of ICU admission, venous thromboembolism, delirium, and readmission; and rates of in-hospital and 1-year mortality, the incidence of postoperative medical complications was significantly lower in the study group (p = 0.003). Conclusion Topical TXA administration appears to be a simple and effective option for reducing blood loss, transfusion requirements, and medical complications after hemiarthroplasty in elderly patients with femoral neck fractures.
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Affiliation(s)
- Dae-Kyung Kwak
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Chul-Young Jang
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Dae-Hwan Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Sang-Hyun Rhyu
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Ji-Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea.
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Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing Complications and Costs of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: A Propensity Score-Matched, Population-Based Study. J Bone Joint Surg Am 2019; 101:572-579. [PMID: 30946190 DOI: 10.2106/jbjs.18.00539] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the prevalence of displaced femoral neck fractures in the elderly population is increasing worldwide, there remains controversy as to whether these injuries should be managed with hemiarthroplasty or total hip arthroplasty. Although total hip arthroplasties result in better function, they are more expensive and may have higher complication rates. Our objective was to compare the complication rates and health-care costs between hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the elderly population. METHODS A population-based, retrospective cohort study was performed on adults (≥60 years of age) undergoing either hemiarthroplasty or total hip arthroplasty for hip fracture between April 1, 2004, and March 31, 2014. We excluded patients who resided in long-term care facilities prior to the injury and those who were discharged to these facilities after the surgical procedure. Patients who underwent a hemiarthroplasty and those who underwent a total hip arthroplasty were matched using a propensity score encompassing patient demographic characteristics, patient comorbidities, and provider factors. After matching, we compared the rates of medical and surgical complications, as well as the perioperative and postoperative health-care costs in the year following the surgical procedure. The primary outcome was the occurrence of a medical complication (acute myocardial infarction, deep venous thrombosis, pulmonary embolism, ileus, pneumonia, renal failure) within 90 days or a surgical complication (dislocation, infection, revision surgical procedure) within 1 year. Additionally, we examined the change in health-care costs in the year following the surgical procedure, including costs associated with the index admission, relative to the year before the surgical procedure. RESULTS Among 29,121 eligible patients, 2,713 (9.3%) underwent a total hip arthroplasty. After successfully matching 2,689 patients who underwent a total hip arthroplasty with those who underwent a hemiarthroplasty, the patients who underwent a total hip arthroplasty were at an increased risk for dislocation (1.7% compared with 1.0%; p = 0.02), but were at a decreased risk for revision (0.2% compared with 1.8%; p < 0.0001), relative to patients who underwent a hemiarthroplasty. Furthermore, the overall increase in the annual health-care expenditure in the year following the surgical procedure was approximately $2,700 in Canadian dollars lower in patients who underwent a total hip arthroplasty (p < 0.001). CONCLUSIONS Among elderly patients with displaced femoral neck fractures, total hip arthroplasty was associated with lower rates of revision surgical procedures and reduced health-care costs during the index admission and in the year following the surgical procedure, relative to hemiarthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hayat Khan
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hans J Kreder
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Vincenten CM, Den Oudsten BL, Bos PK, Bolder SBT, Gosens T. Quality of life and health status after Girdlestone resection arthroplasty in patients with an infected total hip prosthesis. J Bone Jt Infect 2019; 4:10-15. [PMID: 30755842 PMCID: PMC6367196 DOI: 10.7150/jbji.28390] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/14/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction: The Girdlestone resection arthroplasty (GRA) is a salvage procedure for a recurrent or persistent prosthetic joint infection of the hip. This procedure negatively impacts the functional outcome and presumably also diminishes health status (HS) and quality of life (QOL). However, studies investigating the QOL after GRA are lacking. This cross-sectional study compares patients with a Girdlestone situation after an infected total hip prosthesis with a normative population with regard to HS and QOL. Methods: Patients with a permanent GRA were suitable to be enrolled in the study. Subjects completed the World Health Organization Quality of life (WHOQOL-BREF) and the EuroQol 5 dimension 3 level version (EQ-5D-3L). Scores were compared with data from the normal population, from patients with a lower limb amputations and data from patients with a myocardial infarction. Results: Sixty-three patients who underwent GRA between January 2000 and March 2017 completed the questionnaire. The median time between the GRA and competing the questionnaire was 48 months (4 -436). All WHOQOL-BREF domain scores were significantly lower in GRA patients compared to the normative data (p<0.001), patients with myocardial infarction or lower limb amputation. EQ-5D-3L results showed that HS was significantly impaired in GRA patients when compared to normative data (p<0.001) and also impaired when compared to data from lower limb amputations and myocardial infarctions. Conclusion: HS and QOL scores in patients with a permanent Girdlestone situation after an infected hip prosthesis are significantly lower than Dutch normative scores. Patients with a permanent Girdlestone situation scored even lower on HS than patients with a lower limb amputation or a myocardial infarction.
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Affiliation(s)
- Cornelis M Vincenten
- Department of Orthopaedics, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Orthopaedics, Amphia Hospital, Breda, The Netherlands
| | - Brenda L Den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Pieter K Bos
- Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Taco Gosens
- Department of Orthopaedics, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Liu W, Hui H, Zhang Y, Lin W, Fan Y. Intra-Articular Tranexamic Acid Injection During the Hip Hemi-Arthroplasty in Elderly Patients: A Retrospective Study. Geriatr Orthop Surg Rehabil 2018; 9:2151459318803851. [PMID: 30397536 PMCID: PMC6207975 DOI: 10.1177/2151459318803851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/20/2018] [Accepted: 09/09/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction: The objective was to evaluate the safety and efficacy of intra-articular injection of tranexamic acid (TXA) in patients between 80 and 100 years of age with femoral neck fracture undergoing hip hemi-arthroplasty (HA). Material and Methods: We conducted a retrospective review to assess perioperative blood loss and transfusion rate after intra-articular injection of TXA during HA. This was a single-center, retrospective, single-surgeon, and standard care cohort study covering the period between January and December 2016. One hundred three consecutive patients undergoing HA under spinal or general anesthesia were included. Fifty-four and 49 patients received and did not receive intra-articular injection of TXA during the HA, respectively. After closing the capsule, 50 mL of a TXA solution at a concentration of 1 g/100 mL of saline was injected into joint capsule. We compared the following outcomes: preoperative hemoglobin (HB) level, postoperative day 1 HB level, postoperative day 3 HB level, the net reduction of HB level by postoperative day 3, transfusion rate, and 30- and 90-day postoperative mortality rates. In addition, we use logistic regression to analyze the factors affecting the transfusion rate. Result: Day 3 postoperative HB level and the net reduction in HB level within 3 days following surgery were 93.22 ± 11.70 g/L and 25.98 ± 6.29 g/L in TXA group, respectively, while were 87.10 ± 10.52 g/L and 35.44±8.61 g/L in no-TXA group. Transfusion rate was 9% (5/54) in TXA group and 24% (12/49) in no-TXA group, respectively. The differences were statistically significant between the both groups. Logistic regression indicated that the topical administration of TXA would reduce the risk for transfusion, while in male diabetes mellitus would increase the risk. There were no significant differences in the deep venous thrombosis, pulmonary embolism, and mortality rates of 30 and 90 days postoperatively (P > .05). Discussion: Because of lower systemic absorption and a higher concentration in the wound, topical use of TXA is safer for elderly patients who may have renal or liver dysfunction. TXA at therapeutic concentration does not affect platelet count, platelet aggregation, or coagulation parameters, and is of value in elderly patients who take antiplatelet drug for secondary prevention of cardiovascular diseases. Conclusion: For patients between 80 and 100 years of age with femoral neck fracture undergoing HA, intra-articular injection of TXA may reduce the perioperative blood loss and transfusion rate without increasing risk of thrombosis.
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Affiliation(s)
- Wei Liu
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Huangdong Hui
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunhai Zhang
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Weilong Lin
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yongqian Fan
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Lehtonen EJI, Stibolt RD, Smith W, Wills B, Pinto MC, McGwin G, Shah A, Godoy-Santos AL, Naranje S. Trends in surgical treatment of femoral neck fractures in the elderly. ACTA ACUST UNITED AC 2018; 16:eAO4351. [PMID: 30208153 PMCID: PMC6122887 DOI: 10.1590/s1679-45082018ao4351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/12/2018] [Indexed: 12/19/2022]
Abstract
Objective To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients. Methods The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years). Results The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Postoperative complication rates were similar between treatments. Conclusion Demographics and morbidity rates in femoral neck fractures of elderly patients did not change significantly from 2006 to 2015. Open reduction internal fixation was the most common treatment followed by hemiarthroplasty.
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Affiliation(s)
| | | | - Walter Smith
- University of Alabama, Birmingham, AL, United States
| | - Bradley Wills
- University of Alabama, Birmingham, AL, United States
| | | | - Gerald McGwin
- University of Alabama, Birmingham, AL, United States
| | - Ashish Shah
- University of Alabama, Birmingham, AL, United States
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Morcos MW, Hart A, Antoniou J, Huk OL, Zukor DJ, Bergeron SG. No Difference in Major Complication and Readmission Rates Following Simultaneous Bilateral vs Unilateral Total Hip Arthroplasty. J Arthroplasty 2018; 33:2541-2545. [PMID: 29685712 DOI: 10.1016/j.arth.2018.03.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/02/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total hip arthroplasty (THA) is an attractive option for patients with osteoarthritis as it requires a single anesthetic and hospitalization. Nonetheless, serious concerns remain over the perioperative safety and rate of hospital readmission. The purpose of the present study was to compare the rate of 30-day major complications and hospital readmissions between patients undergoing simultaneous bilateral vs unilateral THA using the National Surgical Quality Improvement Program database. METHODS The National Surgical Quality Improvement Program database was queried from 2011 to 2015 inclusively to identify all cases of elective, primary simultaneous bilateral THA and match them to a control group of unilateral THA cases. A multivariable regression analysis was then used to assess the relationship of simultaneous bilateral vs unilateral THA on major complications and readmissions. RESULTS A total of 575 bilateral THA patients were matched to 2290 unilateral THA patients using a 4:1 ratio based on age, sex, and American Society of Anesthesiologists scores. Bilateral THA patients were more likely to undergo general anesthesia (77% vs 58.7%, P < .0001), required more postoperative transfusions (29.2% vs 15.9%, P < .0001) and were more often discharged to a rehabilitation facility rather than home (39.4% vs 20.8%, P < .0001). However, the adjusted odds of a major complication (odds ratio = 0.72, 95% confidence interval [0.41-1.24], P = .24) and 30-day readmission (odds ratio = 0.67, 95% confidence interval [0.38-1.19], P = .17) were similar between the 2 groups. CONCLUSION Although patients who underwent simultaneous bilateral THA were more likely to be discharged to a rehabilitation facility and required significantly more perioperative transfusions compared to those undergoing unilateral THA, the odds of a 30-day major complication and readmission were similar between groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mina W Morcos
- Department of Orthopedic Surgery, McGill University, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - Adam Hart
- Department of Orthopedic Surgery, McGill University, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopedic Surgery, McGill University, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - Olga L Huk
- Department of Orthopedic Surgery, McGill University, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - David J Zukor
- Department of Orthopedic Surgery, McGill University, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
| | - Stephane G Bergeron
- Department of Orthopedic Surgery, McGill University, SMBD-Jewish General Hospital, Montreal, Quebec, Canada
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Boukebous B, Boutroux P, Zahi R, Azmy C, Guillon P. Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: A retrospective case-control study of 199 hips. Orthop Traumatol Surg Res 2018; 104:369-375. [PMID: 29454973 DOI: 10.1016/j.otsr.2018.01.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The choice between performing total hip arthroplasty (THA) or hemiarthroplasty (HA) is not straightforward in older patients with femoral neck fracture, particularly when co-morbidities are factored in. This led us to carry out a case-control study to determine (1) the rate of mechanical complications for these two types of implants, and (2) the rate of medical complications and mortality. HYPOTHESIS THA with dual mobility cup (DM) will result in fewer mechanical complications than HA. PATIENTS AND METHODS This was a single-center, retrospective case-control study. Between 2010 and 2015, all patients with a femoral neck fracture treated by HA or DM THA were included. The primary outcome was the occurrence of any type of surgical complication. The Charlson Co-morbidity Index (CCI) and the independence during Activities of Daily Living (ADL) score were calculated for every patient. Two subgroups of patients were made based on whether they met frailty criteria. The effect of covariates on 1-year mortality was controlled using Cox's proportional hazards regression model. RESULTS The cohort consisted of 101 HA and 98 THA procedures in 193 patients (139 women, 54 men) with a mean age of 80.6years (range, 76-101). The mean follow-up was 24.2months (range, 0-83) with a median of 14.5months. Fifteen of the HA hips (15%) had surgical complication, of which 10 were posterior dislocations (10%). Ten patients in the HA cohort had a serious medical complication (10%). Ten of the THA hips (10%) had a mechanical complication, including three posterior dislocations (3%) and four infections (4%). Nine patients in the THA cohort had a medical complication (9%). There were significantly fewer posterior dislocations in the THA hips (p = 0.05). In the subgroup analysis, the 117 patients (58%) who met the frailty criteria had a significantly lower dislocation rate after undergoing THA (p = 0.048). After adjusting on age, ADL and CCI score, the dislocation rate no longer differed significantly between the two groups (p = 0.1). The dislocation rate was lower in the THA hips only in the "frail" patients (Odds ratio = 0.137, 95% CI: [0.003-0.97] (p = 0.04)). There was no difference in the dislocation rate in the "non-frail" patients. The overall 1-year mortality was 85% [95% CI: 78-94%]. It was 78% [95% CI: 69-86%] for the HA hips and 88% [95% CI: 82-95%] for the THA hips (p = 0.01). After factoring in the impact of age, CCI and ADL, the differences in the 1-year mortality between HA and THA were no longer present (p = 0.42). Thus, there is no increased risk of mortality in THA patients. DISCUSSION When the CCI and independence level are taken into consideration, the frailest patients can undergo DM THA to reduce the dislocation risk, without increasing the mortality rate at 1year. Patients who are not frail will benefit equally from undergoing HA or THA. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- B Boukebous
- Service de chirurgie orthopédique et traumatologique, CH intercommunal le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - P Boutroux
- Service de chirurgie orthopédique et traumatologique, CH intercommunal le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - R Zahi
- Service de chirurgie orthopédique et traumatologique, CH intercommunal le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - C Azmy
- Service de chirurgie orthopédique et traumatologique, CH intercommunal le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - P Guillon
- Service de chirurgie orthopédique et traumatologique, CH intercommunal le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
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Barışhan FC, Akesen B, Atıcı T, Durak K, Bilgen MS. Comparison of hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures. J Int Med Res 2018; 46:2717-2730. [PMID: 29708038 PMCID: PMC6124276 DOI: 10.1177/0300060518770354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective This study was performed to compare the clinical and radiological outcomes of displaced femoral neck fractures (FNFs) treated with either hemiarthroplasty or total hip arthroplasty (THA) in elderly patients. Morbidity and mortality were also evaluated. Methods Twenty-two patients who underwent hemiarthroplasty and 16 patients who underwent THA for treatment of Garden type 3-4 FNFs from 2012 to 2015 were enrolled in this study. All patients were >65 years of age. Cox regression analysis was performed for mortality evaluation. Results The postoperative blood loss volume, decrease in the hemoglobin level, and transfusion rate were significantly higher in the THA group. The univariate mortality risk was higher in patients with a Charlson comorbidity score of >4, American Society of Anesthesiologists score of >2, Singh index of <3, and postoperative hospitalization of >1 week. Conclusion This study revealed no significant difference in the short-term clinical and radiological results between cementless hemiarthroplasty and THA in elderly patients with displaced FNFs. However, morbidity and mortality were associated with the presence of additional systemic diseases. THA is the preferred surgical technique in patients with displaced FNFs and low comorbidities.
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Affiliation(s)
- Fatih Canşah Barışhan
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Burak Akesen
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Teoman Atıcı
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Kemal Durak
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Muhammed Sadık Bilgen
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
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Kim SK, Seo WY, Kim HJ, Yoo JJ. Postoperative Intravenous Ferric Carboxymaltose Reduces Transfusion Amounts after Orthopedic Hip Surgery. Clin Orthop Surg 2018; 10:20-25. [PMID: 29564043 PMCID: PMC5851850 DOI: 10.4055/cios.2018.10.1.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/31/2018] [Indexed: 12/03/2022] Open
Abstract
Background This retrospective study was performed to determine whether postoperative intravenous ferric carboxymaltose reduces transfusion amounts without influencing clinical outcomes in patients that have undergone hip surgery. Methods Between May 2014 and April 2016, the authors adopted a new perioperative blood management protocol involving the administration of intravenous ferric carboxymaltose after hip surgeries. One-to-one matching between the 150 patients treated during this period with 150 patients treated before initiation of the new protocol was performed by propensity scoring for age, sex, diagnosis, and type of hip surgery. Hematologic results and clinical outcomes in these two groups were compared. Results Average amounts of perioperative blood loss were not different in the two groups. Ninety-two patients (61%) were transfused in the control group and 70 patients (47%) were transfused in the intravenous ferric carboxymaltose group. The average number of transfused blood units was significantly lower in the intravenous ferric carboxymaltose group (1.7 ± 2.7 units vs. 1.0 ± 1.2 units, p = 0.002). At 6 weeks after surgery, the average hemoglobin concentration recovered to baseline in both groups, but the amount of recovered hemoglobin concentration at 6 weeks was significantly greater in the intravenous ferric carboxymaltose group than in the control group. Clinical outcomes including incidences of postsurgical complications were similar between the two groups. Conclusions This study suggests that postoperative intravenous ferric carboxymaltose injection is associated with reduced transfusion amounts and that intravenous ferric carboxymaltose does not influence clinical outcomes after hip surgery.
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Affiliation(s)
- Sun Ki Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Yeong Seo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Akinleye SD, Garofolo G, Culbertson MD, Homel P, Erez O. The Role of BMI in Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2018; 9:2151458517747414. [PMID: 29468090 PMCID: PMC5813852 DOI: 10.1177/2151458517747414] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/16/2017] [Accepted: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
Introduction: Obesity is an oft-cited cause of surgical morbidity and many institutions require extensive supplementary screening for obese patients prior to surgical intervention. However, in the elderly patients, obesity has been described as a protective factor. This article set out to examine the effect of body mass index (BMI) on outcomes and morbidity after hip fracture surgery. Methods: The National Surgical Quality Improvement Program database was queried for all patients undergoing 1 of 4 surgical procedures to manage hip fracture between 2008 and 2012. Patient demographics, BMI, and known factors that lead to poor surgical outcomes were included as putative predictors for complications that included infectious, cardiac, pulmonary, renal, and neurovascular events. Using χ2 tests, 30-day postoperative complication rates were compared between 4 patient groups stratified by BMI as low weight (BMI < 20), normal (BMI = 20-30), obese (BMI = 30-40), and morbidly obese (BMI > 40). Results: A total of 15 108 patients underwent surgery for hip fracture over the examined 5-year period. Of these, 18% were low weight (BMI < 20), 67% were normal weight (BMI = 20-30), 13% were obese (BMI = 30-40), and 2% were morbidly obese (BMI > 40). The low-weight and morbidly obese patients had both the highest mortality rates and the lowest superficial infection rates. There was a significant increase in blood transfusion rates that decreased linearly with increasing BMI. Deep surgical site infection and renal failure increased linearly with increasing BMI, however, these outcomes were confounded by comorbidities. Conclusion: This study demonstrates that patients at either extreme of the BMI spectrum, rather than solely the obese, are at greatest risk of major adverse events following hip fracture surgery. This runs contrary to the notion that obese hip fracture patients automatically require additional preoperative screening and perioperative services, as currently implemented in many institutions.
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Affiliation(s)
| | - Garret Garofolo
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Peter Homel
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Orry Erez
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Sonaje JC, Meena PK, Bansiwal RC, Bobade SS. Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:493-498. [PMID: 29030710 DOI: 10.1007/s00590-017-2057-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/05/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare the short-term functional outcome between bipolar hip arthroplasty (BHA) and total hip replacement (THR) in displaced femoral neck fractures in elderly patients in a developing country. MATERIALS AND METHODS A prospective study was conducted which included a total of 42 patients of age more than 60 years with closed displaced femoral neck fractures, and the patients were randomized into two groups of 21 patients each and their outcomes were compared. RESULTS At 24-month follow-up, patients in BHA group had a mean modified Harris hip score of 83.85 ± 6.62 and patients in THR group had a mean modified Harris hip score of 88.00 ± 5.76 (p value = 0.067). Seven (35%) patients in BHA group and 11 (55%) patients in THR group had hip scores from 91 to 100 (excellent), 9 (45%) patients in BHA and seven patients (35%) in THR had hip scores 81-90 (fair) and 4 (20%) patients in BHA group and 2 (10%) patients in THR group were rated 71-80 (good) and none was found in poor category. Total amount of blood loss while performing BHA was 238.15 ± 20.43 ml compared to 336.85 ± 23.56 ml in THR (p < 0.0001). Mean of total duration of surgery was found to be 51.80 ± 8.70 min in BHA group which was significantly lesser than 119.10 ± 16.75 min of THR group (p < 0.0001). CONCLUSION BHA being comparable to THR in terms of functional outcome by modified Harris hip scoring with significantly less blood loss during surgery, less duration of surgery, more cost-effective can be recommended as first line of surgical management in elderly patients with displaced femur neck fractures in developing countries. LEVEL OF EVIDENCE Level II, lesser-quality randomized controlled trial.
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Affiliation(s)
| | - Pradeep Kumar Meena
- Department of Orthopaedics, S.M.S. Medical College and Attached Hospitals, Jaipur, 302004, India. .,Resident Doctor Hostel, S.M.S. Hospital, Jaipur, Rajasthan, 302004, India.
| | - Ramesh Chandra Bansiwal
- Department of Orthopaedics, S.M.S. Medical College and Attached Hospitals, Jaipur, 302004, India
| | - Sandesh Satish Bobade
- Department of Orthopaedics, S.M.S. Medical College and Attached Hospitals, Jaipur, 302004, India
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Chalmers BP, Perry KI, Hanssen AD, Pagnano MW, Abdel MP. Conversion of Hip Hemiarthroplasty to Total Hip Arthroplasty Utilizing a Dual-Mobility Construct Compared With Large Femoral Heads. J Arthroplasty 2017; 32:3071-3075. [PMID: 28579448 DOI: 10.1016/j.arth.2017.04.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/18/2017] [Accepted: 04/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Conversion of hemiarthroplasty to total hip arthroplasty (THA) has a historically high, up to 20%, postoperative dislocation rate. As such, dual-mobility (DM) constructs are an attractive option to mitigate this complication. We analyzed survivorship free of revision, complications, and clinical outcomes of hemiarthroplasties conversion to THAs utilizing DM constructs compared with large femoral heads (≥36 mm). METHODS Conversion of 16 hemiarthroplasties to THAs with a specific DM construct compared with 13 conversions utilizing large femoral heads (≥36 mm) from 2011 to 2014 were reviewed. Mean age at conversion in the DM group was 75 years (range, 57-93 years); 75% were female. Significantly more patients with a dislocated hemiarthroplasty were converted to DM constructs compared to large femoral heads (44% vs 0%; P = .01). Mean follow-up was 3 years. RESULTS Survivorship free of revision was 100% in the DM group compared with 92% in the large femoral head cohort at 2 years (P = .7). One (8%) patient converted to a large femoral head underwent revision to a constrained liner for recurrent dislocations while no patients experienced a postoperative dislocation in the DM group (P = .4). Harris Hip Scores improved from 54 to 82 (P < .01) in the DM group, and from 52 to 86 in the large femoral head group (P < .01). CONCLUSION Larger effective femoral heads used during conversion of hemiarthroplasties to THAs resulted in high survivorship free of revision, minimal complications, and excellent clinical outcomes at short-term follow-up. In patients at highest risk for postoperative dislocation, including those with dislocating hemiarthroplasties, DM constructs resulted in no postoperative dislocations.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Qin CD, Helfrich MM, Fitz DW, Hardt KD, Beal MD, Manning DW. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis. J Arthroplasty 2017; 32:S3-S7. [PMID: 28285039 DOI: 10.1016/j.arth.2017.01.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/15/2017] [Accepted: 01/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes. METHODS The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ2 tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest. RESULTS A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12). CONCLUSION Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes.
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Affiliation(s)
- Charles D Qin
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mia M Helfrich
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David W Fitz
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kevin D Hardt
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew D Beal
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David W Manning
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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