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Fakler JKM, Pieroh P, Höch A, Roth A, Kleber C, Löffler M, Heyde CE, Zeynalova S. Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany. Patient Saf Surg 2024; 18:15. [PMID: 38689330 PMCID: PMC11061946 DOI: 10.1186/s13037-024-00398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture. METHODS This retrospective cohort study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI). RESULTS The 458 included patients had a median age of 83 (IQR 77-89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3-4 vs. 1-2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality. CONCLUSIONS In the present study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.
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Affiliation(s)
- Johannes K M Fakler
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
- Department of Orthopaedic and Trauma Surgery, Hospital of Passau, Innstr. 76, 94032, Passau, Germany.
| | - Philipp Pieroh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christian Kleber
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Markus Löffler
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany
| | - Christoph E Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Samira Zeynalova
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany
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Chung H, Kim Y, Kook I, Kwak JW, Hwang KT. Comparative Short-Term Outcomes of Femoral Neck System (FNS) and Cannulated Screw Fixation in Patients with Femoral Neck Fractures: A Multicenter Study. Clin Orthop Surg 2024; 16:184-193. [PMID: 38562623 PMCID: PMC10973613 DOI: 10.4055/cios23190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/21/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024] Open
Abstract
Background Femoral neck fractures need to be treated in their early stages with accurate reduction and stable fixation to reduce complications. The authors compared the early radiologic outcomes of femoral neck fractures treated with the recently introduced Femoral Neck System (FNS, Depuy-Synthes) with conventional cannulated screws (CS) in a multicenter design. Furthermore, the factors associated with early failure after FNS were analyzed. Methods The FNS group included 40 patients treated between June 2019 and January 2020, and the CS group included 65 patients treated between January 2015 and May 2019. The operation was performed in 3 university hospitals. Patient demographics, fracture classification, postoperative reduction quality, sliding distance of FNS or CS, union and time to union, and complication rates were examined. Logistic regression analysis was performed on candidate factors for early failure of the FNS group. Results The FNS group had a 90% union rate and a mean time to union of 4.4 months, while the CS group had similar results with an 83.1% union rate and a mean time to union of 5.1 months. In the subgroup analysis of Pauwels type III fractures, the union rates were 75.0% and 58.8% in the FNS and CS groups, respectively, and the time to union was significantly shorter in the FNS group with 4.8 months compared to 6.8 months in the CS group. Early failure rate within 6 months of FNS fixation was observed to be 10%, which included 3 reduction failures and 1 excessive sliding with a broken implant. Risk factors for early failure after FNS were identified as displaced fractures (Garden classification type III or IV), poor reduction quality, longer tip-apex distance, greater sliding distance, and 1-hole implants, of which sliding distance was the only significant risk factor in multivariate analysis. Conclusions In femoral neck fractures, FNS and CS did not show significant differences for short-term radiologic results. FNS resulted in shorter operative time than cannulated screw fixation and favorable outcomes in Pauwels type III femoral neck fractures. The FNS could be considered a reliable and safe alternative to CS when treating femoral neck fractures.
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Affiliation(s)
- HoeJeong Chung
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Youngwoo Kim
- Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Woong Kwak
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyu Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
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Bhosale PB, Pawar AV, Patel GB, Rathod PP. Central Fracture-Dislocation of the Hip with Ipsilateral Femoral Neck Fracture in an Elderly Patient with Parkinsonism Managed with Dual Mobility Total Hip Arthroplasty: A Case Report and Review of Literature. J Orthop Case Rep 2024; 14:26-30. [PMID: 38292086 PMCID: PMC10823801 DOI: 10.13107/jocr.2024.v14.i01.4134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The combination of a central fracture-dislocation of the hip, acetabulum fracture, and neck of the femur fracture is a rare injury, with a few reports described in the literature. Guidelines regarding managing this type of injury in single or multiple stages, the requirement of acetabular augmentation with plates, metal rings or cages, and the implant selection in elderly patients are not adequately defined while planning a total hip arthroplasty (THA). The successful management of such a complex fracture pattern in an elderly patient with neurodegenerative disorder is described in our case report. Case Report An 81-year-old male presented to our outpatient department with a 2-month-old neglected post-traumatic central fracturedislocation of the right hip with an ipsilateral femoral neck fracture. The patient had a known case of Parkinson's disease on treatment with oral medication. A single-stage hybrid THA with dual mobility (DM) prosthesis was done with femoral head autograft acetabular impaction bone grafting. The patient was mobilized full weight bearing with the support of a walker on the 2nd post-operative day. At the 1-year follow-up the functional Harris hip score was 87. Radiographs revealed a well-healed acetabular fracture with the incorporation of a bone graft. No signs of implant loosening were observed. We did not encounter any complications such as dislocation, infection, and heterotrophic ossificans. Conclusion Management of central fracture-dislocation of the hip with delayed one-staged THA has a good functional outcome. DM cup is essential in patients with parkinsonism and other neurodegenerative disorders.
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Affiliation(s)
- Pradeep B Bhosale
- Department of Arthritis and Joint Replacement Surgery, Nanavati Hospital, Mumbai, Maharashtra, India
| | - Akshay V Pawar
- Department of Arthritis and Joint Replacement Surgery, Nanavati Hospital, Mumbai, Maharashtra, India
| | - Gazanfar B Patel
- Department of Arthritis and Joint Replacement Surgery, Nanavati Hospital, Mumbai, Maharashtra, India
| | - Pratik P Rathod
- Department of Arthritis and Joint Replacement Surgery, Nanavati Hospital, Mumbai, Maharashtra, India
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Hassan S, Anwar W, Mehta S, Hanif MI, Kamouh A, Blood AJ. Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: a nationwide inpatient sample analysis. BMC Cardiovasc Disord 2023; 23:535. [PMID: 37919652 PMCID: PMC10623838 DOI: 10.1186/s12872-023-03584-2] [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: 07/04/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Hip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures. METHODS A retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS. RESULTS From the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%, p < 0.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1-2.6]), age above 85 years (OR, 3.2[CI, 2.2-4.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2-2.6]), end-stage renal disease (OR, 3.4[CI, 2.7-4.1]), malnutrition (OR, 2.3[CI, 2.1-2.7]) and AS (OR, 1.2[CI, 1.08-1.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1-1.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01-1.4]), cardiogenic shock (OR, 2.0[CI, 1.4-2.9]) and acute renal failure (OR, 1.1[CI, 1.02-1.2]). While hospital stay duration was comparable in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008-2019 though the rate of major in-hospital complications rose. CONCLUSION AS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.
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Affiliation(s)
- Shahzad Hassan
- Boston Medical Center, One Boston Medical Center Pl, Boston University School of Medicine, , Boston, MA, 02118, USA.
| | - Waqas Anwar
- Rawalpindi Medical University, Rawalpindi, 46000, Punjab, Pakistan
| | - Shivani Mehta
- Department of Internal Medicine, Wayne State University/Trinity Health Oakland, Pontiac, MI, 48341, USA
| | - Muhammad Iftikhar Hanif
- Department of Interprofessional Health Sciences and Health Administration, Seton Hall University, South Orange, NJ, 07079, USA
| | - Abdallah Kamouh
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Florence, SC, 29505, USA
| | - Alexander J Blood
- Department of Medicine, Division of Cardiology, Newton Wellesley Hospital, Newton, MA, 02462, USA
- Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Pangaud C, Pauly V, Jacquet C, Orleans V, Boyer L, Khakha R, Argenson JN, Ollivier M. Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture. Sci Rep 2023; 13:16849. [PMID: 37803077 PMCID: PMC10558430 DOI: 10.1038/s41598-023-43790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056-1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731-0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067-1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.
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Affiliation(s)
- Corentin Pangaud
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude 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, APHM, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Christophe Jacquet
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France
| | - Veronica Orleans
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude 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, APHM, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude 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, APHM, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Raghbir Khakha
- Department of Trauma and Orthopaedics, Guys and St Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, UK
| | - Jean Noël Argenson
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France.
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France
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Onggo J, Nambiar M, McDougall C, Hau R, Babazadeh S. Comparing outcomes of total hip arthroplasty versus hemiarthroplasty in neck of femur fracture patients: an Australian registry study. Eur J Trauma Emerg Surg 2023; 49:2147-2153. [PMID: 37355483 PMCID: PMC10520181 DOI: 10.1007/s00068-023-02305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine discharge outcomes of displaced subcapital NOF patients who were from home, with intact pre-operative cognition, ASA 1 or 2 and independent walkers treated with either THA or hemiarthroplasty. METHODS A retrospective registry study was performed using data from the Australia and New Zealand Hip Fracture Registry (ANZHFR). Institutional ethics approval was obtained prior to commencement. Hip fracture registry records between 1st January 2016 and 31st January 2020 were reviewed. RESULTS A total of 930 patients with complete records were identified and included. There were 602 THA and 328 hemiarthroplasty patients. Using multivariate analysis, pre-operative factors associated with THA include younger age (OR = 0.90 for every year older, p < 0.001), females (p = 0.043), private admissions (OR = 1.62, p = 0.028) and receiving pre-operative geriatric assessment (OR = 1.89, p = 0.002). Delay to theatre due to not being fit for surgery was associated with not receiving THA (OR = 0.21, p < 0.001). THA resulted in a shorter total hospital length of stay (MD = 7.24, p < 0.001), higher likelihood of being discharged home (OR = 1.88, p < 0.001) and lower likelihood of being discharged to a residential aged care facility (OR = 0.32, p = 0.019). CONCLUSION Displaced subcapital NOF patients who were admitted from home, had intact pre-operative cognition, ASA 1 or 2, independent walkers and had THAs, had shorter total hospital length of stay, were more likely to be discharged home directly and less likely to end up in residential aged care facilities compared to those undergoing hemiarthroplasty.
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Affiliation(s)
- James Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Catherine McDougall
- Department of Orthopaedic Surgery, Metro North Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
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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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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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Tank P, Patel H, Damor H, Katara D, Patel D. Hemiarthroplasty in geriatric population with neck femur fracture: A retrospective study of 43 cases. MGM JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/mgmj.mgmj_216_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Ali M, Neo C, Rajeev A, Bhatnagar S. The Role of Frailty Scores to Predict the Outcomes in Non Operative Treatment of Valgus Impacted Neck of Femur Fractures. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:112-116. [PMID: 38511421 DOI: 10.14712/18059694.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The management of valgus-impacted neck of femur fracture is controversial between operative and conservative treatments. This study aimed to investigate the usefulness of the Clinical frailty Score for predicting the prognosis of patients who underwent non-operative treatment for the valgus-impacted neck of femur fracture (NOF). METHODS A single-centred retrospective review of patients admitted with valgus impacted NOF. Data were collected from patients' records, including demographics, Clinical Frailty Score (CFS), Nottingham Hip Fracture Score (NHFS) and Abbreviated Mental Test Score (AMTS). Patients were followed up to 24 months postoperatively. RESULTS Fifty-eight patients who were treated non-operatively with a mean follow-up of 2.6 years met our inclusion criteria. Twenty-nine patients failed the non-operative treatment and required replacement surgeries, while 29 had successful outcomes (50%). There were no differences between the two groups' mean age and gender distributions (P 0.527 and 0.139, respectively). The successful group had significantly higher CFS (P 0.013), worse AMTS and higher mortality risk based on the NHFS (P 0.006 and P < 0.001, respectively). CONCLUSION This study demonstrates that CFS, AMTS and NHFS can be used as predictors when considering non-operative treatment for the valgus-impacted neck of femur fracture. Patients who are frail, demented and high risk based on the NHFS have higher success rates with non-operative treatment.
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Affiliation(s)
- Mohammed Ali
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle, United Kingdom.
| | - Chryssa Neo
- Department of Trauma and Orthopaedics, Gateshead health Foundation NHS Trust, Gateshead, United Kingdom
| | - Aysha Rajeev
- Department of Trauma and Orthopaedics, Gateshead health Foundation NHS Trust, Gateshead, United Kingdom
| | - Sharad Bhatnagar
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle, United Kingdom
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11
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Wang J, Zhao C, Yang B. Risk factors for early complications following arthroplasty in elderly patients with a femoral neck fracture. J Back Musculoskelet Rehabil 2022; 36:309-315. [PMID: 36278337 DOI: 10.3233/bmr-220044] [Citation(s) in RCA: 1] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Early complications after arthroplasty for geriatric femoral neck fractures are known to negatively affect postoperative recovery and increase postoperative mortality. Identifying risk factors associated with early complications after arthroplasty may offer an opportunity to address and prevent these complications in many patients. OBJECTIVE To evaluate preoperative risk factors for early complications after arthroplasty in elderly patients with a femoral neck fracture. METHODS 119 elderly patients with femoral neck fractures who had been treated with arthroplasty (hemiarthroplasty or total hip arthroplasty) between December 2015 and December 2018 were retrospectively analysed. Early complications were defined as any complications that did not exist preoperatively, and occurred during hospital stay after arthroplasty Preoperative clinical, epidemiological and laboratory data were collected. Binary univariable and multivariable logistic regression analysis were applied to identify predictors of early complications after arthroplasty for geriatric femoral neck fractures. RESULTS Median age of all patients was 80.0 (IQR 74.0-84.0) years. We identified 28 (23.5%) early complications after arthroplasty. Univariable logistic regression analysis found that preoperative body mass index (BMI p= 0.031), C-reactive protein (CRP p= 0.017) and serum Albumin (p= 0.006) were potential risk factors for early complications. Then preoperative BMI, CRP and serum Albumin were stratified and used for multivariable logistic regression analysis The multivariate logistic regression analysis showed that preoperative higher BMI (⩾ 28 kg/m2; OR 10.440; 95% CI 2.674-41.170; p= 0.001) and lower serum Albumin (⩽ 35 g/L; OR 3.933; 95% CI 1.509-10.800; p= 0.006) were independent risk factors for early complications after arthroplasty in geriatric femoral neck fractures. However, preoperative higher CRP levels (> 10 mg/L; OR 1.139; 95% CI 1034-1428; p= 0.833) was found to be not an independent risk factor for early complications. CONCLUSION Our results demonstrate that obesity and hypoalbuminemia are independent predictors for early complications during hospital stay after arthroplasty, which should be meticulously noted to minimize these risk factors in geriatric femoral neck fractures.
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12
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Chatterji G, Shukla S, Singhania S, Singh MP, Mohanty SS, Jaiswal A, Mishra D. A Prospective Study Comparing the Functional Outcome of Bipolar Hemiarthroplasty Versus Total Hip Replacement in Elderly Patients With Fracture of the Neck of Femur. Cureus 2022; 14:e29529. [PMID: 36312669 PMCID: PMC9590534 DOI: 10.7759/cureus.29529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Displaced fractures of the neck of femur in elderly patients usually require surgical intervention, with either bipolar hemiarthroplasty (BHA) or total hip replacement (THR). However, there is still controversy regarding the optimal prosthesis. The present study was performed to compare the functional outcome of BHA versus THR in elderly patients with displaced fracture of the neck of femur. Materials and methods This prospective study was conducted between December 2019 and December 2021. This study included 40 patients with displaced fracture of the neck of femur. All patients were more than 60 years of age. The patients were randomly allocated to be treated with either BHA or THR. Functional assessment was done using Harris hip scores at one month, three months, six months, and one year postoperatively. Results In our study, at all follow-ups, the Harris hip score was found to be more in patients in the THR group than in the BHA group. In the BHA group, the mean Harris hip scores were 59.95, 66.25, 68.80, and 75.70 at the follow-up visits at one month, three months, six months, and one year, respectively, while in the THR group, the mean Harris hip scores were 65.06, 69.40 72.50, and 78.19, respectively. Conclusion THR is a better option as compared to BHA in the management of elderly patients with fracture of the neck of femur on account of less complication rates and higher Harris hip scores.
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13
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Martin MP, Cole MW, Patel AH, Sherman WF. Gunshot Wound to the Hip Resulting in a Femoral Head and Acetabulum Fracture Treated With Open Reduction and Internal Fixation and Bipolar Hemiarthroplasty. Arthroplast Today 2022; 16:229-236. [PMID: 35880228 PMCID: PMC9307496 DOI: 10.1016/j.artd.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
Abstract
Combined fractures of the femoral head and acetabulum due to ballistic injuries are rare injuries, especially in the elderly. We present a case of a 70-year-old female who sustained a gunshot wound to the left hip, resulting in a comminuted femoral head fracture and posterior wall acetabular fracture. She was treated with open reduction and internal fixation of the acetabulum, as well as bipolar hemiarthroplasty for treatment of her femoral head fracture. At her 18-month follow-up visit, the patient was doing well and had no complaints.
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14
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Ibrahim M, Chiroma M, Salihu M, Awonusi F, Mamuda AA, Abubakar M, Adamu K, Muhammad S, Bello B. Early functional outcome of hemiarthroplasty in the elderly with neck of femur fracture: A single centre’s experience. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:40-46. [PMID: 36213807 PMCID: PMC9536403 DOI: 10.4103/jwas.jwas_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Abstract
Introduction: Neck of femur fractures in the elderly population are common and often a devastating condition. The optimal treatment has been a subject of debate. Arthroplasty has been shown to be the most viable treatment option. The high cost of total hip replacement makes hemiarthroplasty a suitable option in our environment. Materials and Methods: This study was designed to measure the outcome of hemiarthroplasty after femoral neck fracture using Harris hip score in patients aged 60 and above at the National Orthopaedic Hospital, Dala, Kano, Nigeria. Results: Twenty-five consecutive patients 60 years and above with femoral neck fracture who met the inclusion criteria and gave consent were enrolled into the study. The mean Harris hip score at the pre-operative period was 16.92. Fourth week after the surgery, the mean Harris hip score was 69.96. The score rose further to 75.24 and 80.96 at 12 weeks and 6 months post-operatively. The difference between the mean pre-operative and post-operative scores at 4th week, 12th week, and 6th month was statistically significant. During the pre-operative period, all patients had a poor Harris hip score grade. Six months after the surgery, 7 patients (28%) had an excellent Harris hip score grade, 12 patients (48%) had good grades, and 1 patient (4%) had a fair Harris hip score grade. Five patients (20%) had a poor Harris hip score grade at 6 months. Conclusion: From the findings of this study, it can be concluded that early functional outcomes of hemiarthroplasty for femoral neck fracture in the elderly are good and satisfactory.
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15
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Ben-Haim G, Zabatani A, Orion D, Leshem E, Irony A, Katorza E. The Pandemic's impacts on patients without Covid-19 on multidisciplinary aspects in emergency medicine care. Intern Emerg Med 2021; 16:2261-2268. [PMID: 33650082 PMCID: PMC7920545 DOI: 10.1007/s11739-021-02680-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022]
Abstract
The emergence of Covid-19 has caused a pandemic and is a major public health concern. Covid-19 has fundamentally challenged the global health care system in all aspects. However, there is a growing concern for the subsequent detrimental effects of continuing delays or adjustments on time-dependent treatments for Covid-19 negative patients. Patients arriving to the ED with STEMIs and acute CVA are currently presumed to have delays due to Covid-19 related concerns. The objective of this paper is to evaluate the implications of the Covid-19 pandemic on non-Covid19 patients in emergency care settings. We conducted a retrospective study from February 2020 to April 2020 and compared this to a parallel period in 2019 to assess the impact of the Covid-19 pandemic on three distinct non-Covid-19 ED diagnosis that require immediate intervention. Our primary outcome measures were time to primary PCI in acute STEMI, time to fibrinolysis in acute CVA, and time to femoral hip fracture correction surgery. Our secondary outcome measure included a composite outcome of length of stay in hospital and mortality. From 1 February 2020 to 30 April 2020, the total referrals to ED diagnosed with STEMI, Hip fracture and CVA of which required intervention were 197 within Covid-19 group 2020 compared to 250 in the control group 2019. Mean duration to intervention (PCI, surgery and tPA, respectively) did not differ between COVID-19 group and 2019 group. Among femoral hip fracture patients', the referral numbers to ED were significantly lower in Covid-19 era (p = 0.040) and the hospitalization stay was significantly shorter (p = 0.003). Among CVA patients', we found statistical differences among the number of referrals and the patients' age. Coping with the Covid-19 pandemic presents a challenge for the general healthcare system. Our results suggest that with proper management, despite the obstacles of isolation policies and social distancing, any negative impact on the quality of health care for the non-Covid-19 patients can be minimized in the emergency department setting.
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Affiliation(s)
- Gal Ben-Haim
- Department of Emergency Medicine, Chaim Sheba Medical Center, 52621, Ramat-Gan, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Amit Zabatani
- Department of Orthopedics, Sheba Medical Center, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Orion
- Acute Stroke and Neuro-Endovascular/Neuro-Interventional Unit and Stroke Center, Sheba Medical Center, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Leshem
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avinoah Irony
- Department of Emergency Medicine, Chaim Sheba Medical Center, 52621, Ramat-Gan, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eldad Katorza
- Department of Medical Management, Sheba Medical Center, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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16
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Jaya Raj J, Kow RY, Ganthel Annamalai K, Kunasingh DE, Panicker GK, Lim BC, Low CL. Outcomes of Femoral Neck Fractures in Young Patients and the Factors Associated With Complications: A Multicenter Study From Malaysia. Cureus 2021; 13:e18110. [PMID: 34692321 PMCID: PMC8527184 DOI: 10.7759/cureus.18110] [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] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Femoral neck fractures are relatively rare in young adults, but they result in prolonged loss of function in these patients, thereby placing a huge burden on a country's healthcare and economy. Femoral neck fractures in young adults are normally treated with head salvage surgery. However, primary head replacement surgeries have been gaining traction recently to expedite the recovery of these patients. In this study, we aimed to investigate the outcomes in young patients with femoral neck fractures and factors associated with their complications. Patients and methods Patients with femoral neck fractures who underwent surgery in three tertiary hospitals [Hospital Tengku Ampuan Afzan (HTAA), Hospital Sultan Haji Ahmad Shah (HOSHAS), and Hospital Kuala Lipis] in Pahang state in Malaysia were reviewed and included in this study. The demographic profile of the patients, injury patterns, intervention details, functional outcomes, and complications were analyzed. The comparison between the sociodemographics, clinical assessment, and complication outcomes was analyzed using statistical software. Results The complications were associated with the mechanism of injury, capsulotomy, and type of fixation. A total of 46 patients were included in the study. Most of the patients were found to have severe displacement based on Garden and Pauwels classification. The majority of the patients underwent femoral head salvage surgeries. Almost half of the patients sustained complications and were unable to achieve weight-bearing status at six months postoperatively. Conclusion Despite a relatively short follow-up period in our study, femoral neck fractures in young adults were found to be associated with a high rate of complications. Primary head replacement surgeries should be considered in high-risk patients with femoral neck fractures.
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Affiliation(s)
- Jeffrey Jaya Raj
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Ren Yi Kow
- Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS.,Orthopaedics, International Islamic University Malaysia, Kuantan, MYS
| | | | | | | | - Bee Chiu Lim
- Clinical Research, Hospital Tengku Ampuan Afzan, Kuantan, MYS
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17
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Agarwala S, Katariya A, Vijayvargiya M, Shetty V, Swami PM. Superior functional outcome with dual mobility THR as compared to conventional THR in fracture neck femur: a prospective cohort study. SICOT J 2021; 7:42. [PMID: 34402791 PMCID: PMC8370015 DOI: 10.1051/sicotj/2021041] [Citation(s) in RCA: 4] [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: 05/05/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Total Hip Replacement (THR) in displaced Fracture Neck of Femur (FNOF) is associated with higher dislocation rates. Conventional THR with a large femoral head and anterior approach has reduced the instability, but it remains higher than THR done for other aetiology. Recent studies have shown reduced dislocation rates with dual mobility THR (DMTHR) for FNOF; however, there is a lack of comparative research to show its superiority over conventional THR. Further, its role in the Asian subcontinent, where the patient requires sitting cross-legged or squatting, has not been studied. Methods: A prospective cohort study of 103 elderly patients with displaced FNOF with a minimum follow-up of 1-year. Fifty-two patients were operated on with DMTHR and fifty-one patients with conventional THR. Both the groups were matched in terms of demographic data, surgical approach, and postoperative protocol. Radiological and functional outcomes in terms of Harris Hip Score (HHS), Range of motion, Patient Reported Outcome Measures (PROM), and Dislocation rate were compared between the two groups. Results: Mean HHS of the DMTHR group was 76.37 at three months and 87.02 at the end of the 1-year postoperatively, which was significantly better than the conventional THR group 65.65 at three months and 72.96 at 1-year. The range of motion was significantly better in the DMTHR group than the conventional THR group. There was no significant difference in radiological outcomes and postoperative dislocation rate between the two groups. Conclusion: Dual mobility implants give better results than conventional implants for primary THA in elderly patients of displaced FNOF regarding better function and greater range of motion.
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Affiliation(s)
- Sanjay Agarwala
- Chief of Surgery and Director Professional Services, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Ameya Katariya
- Resident doctor, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Mayank Vijayvargiya
- Junior Consultant, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Vivek Shetty
- Consultant, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Pravin Manohar Swami
- Resident doctor, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
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18
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Lee SH, Han Y, Kim SJ, Lee SJ, Ryu YJ. Impact of right ventricular systolic pressure in elderly patients admitted to intensive care unit after femur fracture surgery: A retrospective observational study. Medicine (Baltimore) 2020; 99:e22881. [PMID: 33157931 PMCID: PMC7647512 DOI: 10.1097/md.0000000000022881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The number of femoral fractures is expected to continue to increase as the size of the older population rapidly grows. However, old age is accompanied by various comorbidities and is an important postoperative risk factor in itself, meaning that patients who undergo surgery for a femur fracture may require admission to an ICU. We investigated pulmonary complications in patients over the age of 65 admitted to the ICU after femur fracture surgery.In this single-center retrospective observational study, 289 patients over 65 years who admitted to the ICU after femur fracture surgery between June 2008 and December 2016 were investigated.Pulmonary complications occurred in 97 of these patients (33.6%) after surgery. Mean hospitalization days (34.1 ± 25.7 vs 23.1 ± 15.7, P < .001) and mean ICU length of stay (8.4 ± 16.1 vs 2.5 ± 1.1, P = .001) were significantly longer for patients with pulmonary complications than for patients without pulmonary complications after femur fracture surgery. Patients with pulmonary complications were significantly more likely to have pulmonary disease (19.6% vs 8.9%, P = .009) and exhibit sequelae on preoperative chest X-rays (9.3% vs 3.6%, P = .048) than were patients without pulmonary complications. In addition, significant differences were observed in the right ventricular systolic pressure (RVSP) measured during preoperative echocardiography (37.4 ± 10.9 mm Hg vs 40.7 ± 9.3 mm Hg for patients without and with pulmonary complications, P = .010) and in the proportion of each group that had an RVSP of >35 mm Hg, which is a marker for pulmonary hypertension (55.2% vs 76.3% for patients without and with pulmonary complications, P < .001). In multivariate analysis, an RVSP of >35 mm Hg during preoperative echocardiography was associated with pulmonary complications after femur fracture surgery (OR, 2.6; 95% CI, 1.45-4.53).In conclusion, Pulmonary complications in older patients admitted to the ICU after femur fracture surgery was associated with longer hospitalization and ICU stays. Preoperative RVSP measurement could identify those older patients with a high risk of pulmonary complications following transferal to the ICU after femur fracture surgery.
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Affiliation(s)
- Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine
| | - Yeji Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
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19
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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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20
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Chang CH, Tsai SW, Wu PK, Chen CM, Chang MC, Chen WM, Chen CF. Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients. Hip Int 2020; 30:474-480. [PMID: 31232109 DOI: 10.1177/1120700019859842] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate outcomes of internal fixation for displaced femoral neck fracture (FNF) between 50 and 60 years old. The patient and surgical factors for the failure were identified. METHODS We retrospectively reviewed the records of 102 displaced FNF patients between 50 and 60 years old (mean age 54.9 years) who had undergone internal fixation between 2005 and 2016. The minimum follow-up was 12 months. Primary end points included loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH). Preoperative Pauwel's angle, fixation timing and methods, reduction quality, removal of implant and medical comorbidities were analysed. RESULTS The overall failure rate was 44.1%. In multivariate logistic regression analysis, poor reduction quality (adjusted odds ratio [aOR] 4.38; 95% confidence interval [CI], 1.54-12.46) and internal fixation delayed more than 6 hours (aOR 3.24; 95% CI, 1.08-9.69) were risk factors for all causes of failure. In a stratified analysis, poor reduction quality (aOR 3.81; 95% CI, 1.11-13.04) and a history of alcohol dependency (aOR 4.91; 95% CI, 1.09-22.13) were risk factors for loss of reduction. Internal fixation delayed >6 hours (aOR 3.67; 95% CI, 1.05-12.77) and removal of implant (aOR 3.32; 95% CI, 1.02-10.77) were risk factors for ONFH. CONCLUSIONS The outcome of internal fixation of displaced FNF in patients between 50 and 60 years old is suboptimal. The patient selection is important. Non-alcohol dependency lowered early failure. Implant retention reduced ONFH. Surgery within 6 hours and good quality of reduction yield better results.
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Affiliation(s)
- Chun-Hung Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Chao-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
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21
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López-Torres II, Sanz-Ruiz P, Montero-Fernández N, Chana F, Serra-Rexach JA, Benjumea-Carrasco A, Vaquero-Martín J. Surgical treatment of hip fracture in centenarians: Complications and independent risk factors of death. Injury 2020; 51 Suppl 1:S25-S29. [PMID: 32409187 DOI: 10.1016/j.injury.2020.03.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/03/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The increase in life expectancy has led to the appearance of a subgroup of hip fracture (HF) patients with special characteristics known as centenarians. The aim of the present study is to analyse the demographic characteristics, complications and mortality rate of this subgroup in order to identify the specific risk factors for mortality in these patients. METHODS Retrospective analysis of 69 patients (58 women and 11 men) aged 100 years or older admitted to a tertiary hospital for HF between 1999 and 2018. RESULTS The average age was 101.3 years (100-108, median 101). More than half (62.3%) of all patients presented with extracapsular fractures. The most common complications observed were delirium (52.3%) and urinary retention (27.7%). Haematoma (9.2%) was the most common surgical complication. Only 3 patients (7.3%) changed their place of residence after admission. In-hospital, 30-day and 1-year mortality rates were 13.8%, 21.5% and 54.2%, respectively. A high Charlson Comorbidity Index and baseline Functional Ambulation Classification (FAC) <3 were associated with a higher in-hospital mortality rate (OR = 1.95 95% CI [1.03-3.69] and OR = 5.7 95% CI [1.2-26.8]), respectively. The presence of more than 3 comorbidities and baseline FAC <3 were associated with a higher risk of 30-day mortality (OR = 6, 95% CI [1.4-24.7] and OR = 4, 95% CI [1.13-14.2]), respectively. Dementia has been associated with a higher risk of 30-day and 1-year mortality (OR = 4.6, 95% CI [1.2-16.7]) and OR = 5.11, 95% CI [1.6-21]) respectively. CONCLUSION FAC score, number of comorbidities, dementia and the Charlson Comorbidity Index have been shown to be risk factors of mortality in centenarians with HF.
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Affiliation(s)
| | - Pablo Sanz-Ruiz
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
| | | | - Francisco Chana
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES). Avenida de Monforte de Lemos, 3-5. Pabellón 11, 28029 Madrid, Spain.
| | | | - Javier Vaquero-Martín
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
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Filippo M, Driessen A, Colarossi G, Quack V, Tingart M, Eschweiler J. Bipolar versus monopolar hemiarthroplasty for displaced femur neck fractures: a meta-analysis study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:401-410. [DOI: 10.1007/s00590-019-02600-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022]
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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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Arsic A, Pesic G, Petrovic S, Matic A, Jeremic J, Jakovljevic V, Vucic V. Adverse plasma fatty acid composition in patients with femoral neck fracture 1. Can J Physiol Pharmacol 2019; 98:61-66. [PMID: 31491342 DOI: 10.1139/cjpp-2019-0249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Our study aimed to examine the status of plasma fatty acids (FAs), inflammatory markers, and lipid peroxidation in patients with femoral neck fractures. The study included 20 patients (64-86 years) with femoral neck fractures indicated for surgery and a control group of 17 elderly subjects without fractures or serious chronic diseases. Plasma was obtained during the first 12 h postfracture and presurgery and 7 days postop. Compared to the control, patients had significantly higher saturated FA (SFA) and monounsaturated FA as well as increased TNF-α and IL-6. Opposite to that, levels of individual and total n-6 polyunsaturated FA (PUFA), individual and total n-3 PUFA, n-6/n-3 ratio, and levels of thiobarbituric acid reactive substances (TBARS) were markedly lower in the patient than in the controls. On the seventh day after the surgery, we showed a further rise in the SFA, oleic acid, and TNF-α and reductions of n-6 PUFA and IL-6. Taken together, our results suggest that altered FA status, especially reduced PUFA, may influence hip fracture repair and even contribute to femoral fracture susceptibility in the elderly. A potential benefit from nutritional intervention with PUFA in prevention and (or) fracture healing should be considered.
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Affiliation(s)
- Aleksandra Arsic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Goran Pesic
- Orthopedic and Traumatology Clinic, Podgorica, Montenegro
| | - Snjezana Petrovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Matic
- Clinic of Orthopedic Surgery, Clinical Centre of Kragujevac, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jovana Jeremic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vesna Vucic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
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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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Mugalur A. Bridging the gap: A technique to avoid limb length discrepancy in arthroplasty for femoral neck fracture - a case report. J Clin Orthop Trauma 2018; 9:S17-S20. [PMID: 29928097 PMCID: PMC6008607 DOI: 10.1016/j.jcot.2017.11.003] [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] [Received: 09/25/2017] [Revised: 10/15/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022] Open
Abstract
Equalizing limb length is of paramount importance for optimal outcome in patients undergoing hip arthroplasty(HA). Numerous techniques have been described for avoiding limb length discrepancy (LLD) in patients undergoing HA. However their applicability in patients undergoing HA for neck of femur(NOF) fractures remains questionable due to dissociation between the femur and the head. I hereby describe a novel yet simple technique for better utilization of already established techniques to avoid LLD in NOF fractures undergoing HA. After exposure of hip, the proximal head and neck fragment is extracted taking care not to damage bone at fracture site. Proximal fragment is provisionally fixed to distal fragment in a retrograde manner using 6.5 mm cannulated screws after predrilling over guide wires. Horizontal and vertical offsets are measured. The hip joint is reduced and a mark is made on greater trochanter (GT) utilizing the co-axial stitch method. The joint is dislocated & screws removed.THR is done in a routine manner taking care to establish and recreate native anatomy of hip. Limb length is ascertained utilizing the previous mark on GT. Recreation of proximal femoral anatomy helps in better utilization of already established techniques to avoid LLD and helps us to re-create the native anatomy in HA. It is simple, less time consuming and doesn't require extensive armamentarium or image guidance for its applicability. However it needs to be validated and its advantages might be undermined in old NOF fractures with resorption of the neck or in severely communited fractures.
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27
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Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture. Eur J Trauma Emerg Surg 2018; 45:207-212. [DOI: 10.1007/s00068-018-0909-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/12/2018] [Indexed: 12/26/2022]
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28
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González Quevedo D, Mariño IT, Sánchez Siles JM, Escribano ER, Granero Molina EJ, Enrique DB, Smoljanović T, Pareja FV. Patient survival and surgical re-intervention predictors for intracapsular hip fractures. Injury 2017; 48:1831-1836. [PMID: 28655397 DOI: 10.1016/j.injury.2017.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Choosing between total hip replacement (THR) and partial hip replacement (PHR) for patients with intracapsular hip fractures is often based on subjective factors. Predicting the survival of these patients and risk of surgical re-intervention is essential to select the most adequate implant. METHODS We conducted a retrospective cohort study on mortality of patients over 70 years with intracapsular hip fractures who were treated between January 2010 and December 2013, with either PHR or THR. Patients' information was withdrawn from our local computerized database. The age-adjusted Charlson comorbidity index (ACCI) and American Society of Anesthesiologists (ASA) score were calculated for all patients. The patients were followed for 2 years after surgery. Survival and surgical re-intervention rates were compared between the two groups using a Multivariate Cox proportional hazard model. RESULTS A total of 356 individuals were included in this study. At 2 years of follow-up, 221 (74.4%) of the patients with ACCI score≤7 were still alive, in contrast to only 20 (29.0%) of those with ACCI score>7. In addition, 201 (76.2%) of the patients with ASA score≤3 were still alive after 2 years, compared to 30 (32.6%) of individuals with ASA >3. Patients with the ACCI score>7, and ASA score>3 had a significant increase in all-cause 2-year mortality (adjusted hazard ratio of 3.2, 95% CI 2.2-4.6; and 3.12, 95% CI 2.2-4.5, respectively). Patients with an ASA score>3 had a quasi-significant increase in the re-intervention risk (adjusted hazard ratio 2.2, 95% CI 1.0-5.1). The sensitivity, specificity, positive predictive value and negative predictive values of ACCI in predicting 2-year mortality were 39.2%, 91.1%, 71%, and 74.4%, respectively. On the other hand, the sensitivity, specificity, positive predictive value and negative predictive values of ASA score in predicting 2-year mortality were 49.6%, 79.1%, 67.4%, and 76.1%, respectively. CONCLUSIONS Both ACCI and ASA scales were able to predict the 2-year survival of patients with intracapsular hip fractures. The ASA scale was also able to predict the risk of re-intervention in these patients.
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Affiliation(s)
- David González Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Spain.
| | - Iskandar Tamimi Mariño
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Spain
| | | | - Esther Romero Escribano
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Spain
| | | | - David Bautista Enrique
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Spain
| | - Tomislav Smoljanović
- Department of Orthopedic Surgery and Traumatology, University Hospital Centre of Zagreb, Croatia
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Comparison of total costs between internal fixation and hemiarthroplasty for displaced femoral neck fractures. J Orthop Sci 2017; 22:75-80. [PMID: 27693203 DOI: 10.1016/j.jos.2016.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is very little information on the costs of different surgeries for displaced femoral neck fractures. This study aimed to compare the costs between internal fixation and hemiarthroplasty (HA) in the treatment of displaced femoral neck fracture. METHOD A total of 142 patients aged 65 years or older who had been randomized into internal fixation group (n = 70) or HA group (n = 72) were followed for 2 years. Cost data was collected through hospitalization information, cost diary and telephone interview. Sensitivity analysis was performed for missing diaries. The total costs were collected and compared between the two groups. RESULTS All diaries were completed by 69.7% of patients. The mean costs of primary treatment were significantly lower for internal fixation (CNY 21,631) compared with HA (CNY 51,641) (p < 0.001). The mean post-discharge costs were similar for both procedures: CNY 37,377 for internal fixation and CNY 34,981 for HA (p = 0.640). The mean total costs for internal fixation were CNY 59,008, which was significantly lower than the mean total costs of CNY 86,622 for HA (p = 0.002). CONCLUSION Although the post-discharge costs of internal fixation were slightly higher, the total costs were still lower than for HA due to great variance in costs of primary treatment. In China, internal fixation may be less costly than HA for displaced femoral neck fracture treatment.
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Döring R, Jentzsch T, Scheyerer MJ, Pfäffli W, Werner CML. The value of modular hemiarthroplasty for unstable femoral neck fractures in elderly patients with coxarthrosis. BMC Musculoskelet Disord 2016; 17:223. [PMID: 27215472 PMCID: PMC4877940 DOI: 10.1186/s12891-016-1068-x] [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: 10/15/2015] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Displaced femoral neck fractures are common in the elderly patient. The surgical treatment options consist of a hemiarthroplasty (HA) or total hip arthroplasty (THA). However, the best surgical choice is still under debate. Bipolar HAs do not address preexisting arthritic changes of the acetabulum, which may lead to an unfavorable clinical outcome. The purpose of the present study was to conduct a long term follow-up analysis of the bipolar hemiarthroplasty with particular focus on the influence of preoperative acetabular osteoarthritis on the functional outcome. Methods In a retrospective observational study, the medical charts of consecutive patients treated with a bipolar hemiarthroplasty at a level one trauma center between 2004 and 2008 were reviewed before a final radiographic and clinical follow-up was performed. The outcome variables consisted of arthritic findings on the pre- and postoperative x-rays with particular focus on double fond osteophyte (DFO) and posterior wall sign (PWS) as well as the revision rate and functional scores. Results This study included 102 patients with a mean age of 77.2 years. Most patients (75 %) had a Kellgren-Lawrence grading scale (KLGS) of 2 or 3. While only 30 % of patients had a DFO, most patients (73 %) had a PWS. The DFO correlated significantly with the KLGS, but no correlation was seen with the clinical outcome. Most patients showed a decreased offset by a mean of −7.8 mm. The mean modified Harris Hip Score (HHS) of 90.3 and the mean Merle d'Aubigné score of 10.8 correlated significantly. Despite a significant correlation of the HSS subcategory of pain and the preoperative KLGS, there was no statistical relationship between the arthritic x-ray measurements and the clinical outcome. Conclusions In the presented study population, the presence of radiographic acetabular osteoarthritis did not influence the clinical outcome after bipolar hemiarthroplasty for displaced femoral neck fractures.
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Affiliation(s)
- Robert Döring
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Thorsten Jentzsch
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Max J Scheyerer
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - William Pfäffli
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Clément M L Werner
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome Analysis of Hemiarthroplasty vs. Total Hip Replacement in Displaced Femoral Neck Fractures in the Elderly. J Clin Diagn Res 2016; 10:RC11-3. [PMID: 27437316 DOI: 10.7860/jcdr/2016/18638.7877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/02/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Management of displaced fracture neck femur in the elderly population is frequently done by Hemiarthroplasty or Total Hip Replacement (THR). It avoids high rates of nonunion and avascular necrosis which usually occur after internal fixation of neck femur fractures in this age group. AIM The present study aimed to evaluate patient function and complications following hemiarthroplasty and total hip replacement in elderly population with displaced femoral neck fractures. MATERIALS AND METHODS Patients above 60 years of age with displaced fracture neck femur were studied over the period of four years. All the clinical parameters and co-morbid conditions were noted at the time of presentation. The patients associated with co-morbid conditions and underlying pathology were excluded from study. Garden's classification was used for classification of neck femur fractures. After due informed consent patients of displaced fracture neck femur were randomized by simple randomization and allocated for hemiarthroplasty or THR. Antibiotics were given preoperatively at the time of induction and postoperatively for 5-7 days. Surgery was carried out by Modified Gibson approach. Any complications during pre and postoperative period were noted. Follow-up of patients was done 1 month, 3 months, 6 months and 1 year interval with the help of Harris hip score. RESULTS Total 80 patients were enrolled in the study group, with 40 patients in each group. The mean age of patients was 73 years in hemiarthroplasty group and 78 years in THR group. Female to male ratio was 55:45. Mean operative time was 35 minutes in hemiarthroplasty group and 45 minutes in THR. Average intraoperative blood loss was 200cc and 300cc in hemiarthroplasty and THR respectively. The mean hospital stay was 14 days in both the groups. Superficial wound infection was noted in hemiarthroplasty group while in THR group deep wound infection (n=1) and prolonged ICU stay (n=1) were noted. The mean Harris hip score was better in THR group as compared to Hemiarthroplasty group at one year follow-up. CONCLUSION In elderly patients with fracture neck femur hemiarthroplasty takes less operative time, less blood loss per operatively and few complications postoperatively as compared to THR. The functional outcome at one year is better with THR as compared to hemiarthroplasty.
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Affiliation(s)
- Vipin Sharma
- Associate Professor, Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College , Himachal Pradesh, India
| | - Bhanu Awasthi
- Professor and Head, Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College , Himachal Pradesh, India
| | - Krishna Kumar
- Student, Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College , Himachal Pradesh, India
| | - Navneet Kohli
- Student, Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College , Himachal Pradesh, India
| | - Punit Katoch
- Student, Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College , Himachal Pradesh, India
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Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P. Total Hip Arthroplasty for Failed Internal Fixation After Femoral Neck Fracture Versus That for Acute Displaced Femoral Neck Fracture: A Comparative Study. J Arthroplasty 2015; 30:1378-83. [PMID: 25769744 DOI: 10.1016/j.arth.2015.02.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/06/2015] [Accepted: 02/23/2015] [Indexed: 02/05/2023] Open
Abstract
The outcome of total hip arthroplasty (THA) for failed internal fixation after femoral neck fracture (FNF) versus that for acute displaced femoral neck fracture is still controversial. This study retrospectively analyzed a consecutive series of 130 THAs for acute displaced FNF (64, group I) and for failed internal fixation (66, group II). Results showed THAs in group II were more technically demanding procedures with longer operative time and larger amounts of drainage compared to that in group I. Furthermore, multivariate analysis revealed that the associations between THAs (group II) and hip complications were notable (OR=4.15, P=0.017). These increased risks should be paid much attention to, not only for choosing the appropriate treatment option, but also for providing effective perioperative care.
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Affiliation(s)
- Zhouyuan Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaowei Xie
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Tan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Tianqiang Qin
- Chinese Evidence-Based Medicine Centre/Cochrane Center, West China Hospital, Chengdu, China
| | - Pengde Kang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Nash W, Harris A. The Dorr type and cortical thickness index of the proximal femur for predicting peri-operative complications during hemiarthroplasty. J Orthop Surg (Hong Kong) 2014; 22:92-5. [PMID: 24781623 DOI: 10.1177/230949901402200123] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the Dorr proximal femoral types and the cortical thickness index for predicting peri-operative complications during hemiarthroplasty. METHODS Records of 53 male and 147 female elderly who underwent cemented or uncemented monopolar hemiarthroplasty for displaced intracapsular femoral neck fractures were reviewed. Any intra-operative fracture and postoperative dislocation within 30 days was recorded. The cortical thickness index was defined as the ratio of cortical width minus endosteal width to cortical width at a level of 100 mm below the tip of the lesser trochanter. Higher values indicated thicker cortices. The Dorr proximal femur morphology was classified into types A, B, and C. RESULTS 28 patients were excluded. The proximal femurs of the remaining 172 patients (mean age, 85 years) were categorised as Dorr type A (n=29), type B (n=75), and type C (n=68). The respective mean cortical thickness indices were 1.10, 0.79, and 0.65. Lower cortical thickness indices correlated with worse Dorr types (p<0.05). There were 18 intra-operative fractures; 8 and 10 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.046). There were 5 postoperative dislocations; 3 and 2 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.591). The mean cortical thickness index was significantly lower in those with a fracture (n=18) than those without a fracture (n=154) [0.59 vs. 0.81, p=0.0003]. CONCLUSION Dorr types B and C proximal femurs were at greater risk of intra-operative fracture.
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Affiliation(s)
- William Nash
- SE Thames Rotation, Queen Elizabeth Hospital, London, United Kingdom
| | - Andrew Harris
- Belfast Hospitals NHS Trust, Belfast, Northern Ireland, United Kingdom
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Jameson SS, Lees D, James P, Johnson A, Nachtsheim C, McVie JL, Rangan A, Muller SD, Reed MR. Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data. Injury 2013; 44:1940-4. [PMID: 23618782 DOI: 10.1016/j.injury.2013.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 02/09/2013] [Accepted: 03/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The treatment of choice for intracapsular neck of femur (NOF) fractures in younger, more active patients remains unknown. Some surgeons advocate total hip replacement (THR). AIM This study aimed to compare complications following THR and hemiarthroplasty using the Hospital Episode Statistics (HES) database in England. METHOD Dislocation and revision rates were extracted for all patients with NOF fracture who underwent either cemented hemiarthroplasty or cemented THR between January 2005 and December 2008. To make a 'like for like' comparison all 3866 THR patients were matched to 3866 hemiarthroplasty patients (from a total of 41,343) in terms of age, sex and Charlson score. RESULTS AND CONCLUSION Eighteen-month dislocation was significantly higher in the THR group (2.4% vs. 0.5%, odds ratio (OR) 3.90 (2.99-5.05), p<0.001). This difference was sustained at the 4-year stage (2.9% vs. 0.9%, OR 3.18 (1.58-6.94), p=0.001) in a subset of patients with longer follow-up. There was no significant difference in revision rate up to 4 years (1.8% vs. 2.1%, OR 0.85 (0.46-1.55), p=0.666). In this national analysis of matched patients short- and medium-term dislocation rates following THR were significantly higher than following cemented hemiarthroplasty, without any difference in revision rates at 4 years. The low risk of dislocation may be acceptable in order to experience the apparent functional benefits of THR.
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Affiliation(s)
- Simon S Jameson
- National Orthopaedic Research and Surgical Outcomes Collaboration, UK; Northern Deanery Trauma & Orthopaedic Training Scheme, Waterfront 4, Goldcrest Way, Newcastle NE15 8NY, UK.
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Patil S, Parcells B, Balsted A, S. Chamberlain R. Surgical Outcome Following Hip Fracture in Patients > 100 Years Old: Will They Ever Walk Again? ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ss.2012.311109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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