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Gjertsen JE, Nilsen D, Furnes O, Hallan G, Kroken G, Dybvik E, Fenstad AM. Promoting cemented fixation of the femoral stem in elderly female hip arthroplasty patients and elderly hip fracture patients: a retrospective cohort study from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register. Acta Orthop 2024; 95:130-137. [PMID: 38391278 PMCID: PMC10885817 DOI: 10.2340/17453674.2024.40073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population. METHODS 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015-2017 and 2019-2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan-Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint. RESULTS The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015-2017 to 2.1% in 2019-2021 (aHRR 0.7, 95% confidence interval [CI] 0.5-0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015-2017 to 3.3% in 2019-2021 (aHRR 0.6, CI 0.4-0.8) at the intervention hospitals. CONCLUSION The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.
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Affiliation(s)
- Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen.
| | - Daniel Nilsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Gard Kroken
- Directorate of Fisheries, Section for Analysis and Risk Assessment, Bergen, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
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Moore J, Berney M, Walsh M, Hurson C, Rowan F, Cleary M, Brent L. Intracapsular hip fractures: A comparative study of cemented and uncemented hemiarthroplasties in the Irish hip fracture database. Surgeon 2023:S1479-666X(23)00148-8. [PMID: 38135630 DOI: 10.1016/j.surge.2023.11.011] [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: 05/02/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The aim of this study was to analyse the association between use of cement for stem fixation in hip hemiarthroplasty and the outcomes of mobility, mortality, and discharge destination. METHODS The Irish Hip Fracture Database was examined from 2016 to 2020 to assess for any difference in post op mobility, 7-day, 14-day and inpatient mortality, and discharge destination. RESULTS A total of 7109 hemi-arthroplasties were identified from 2016 to 2020. 71.6 % were cemented (n = 5,172), with 28.4 % uncemented (1,937). There was no difference in day 1 post op mobilisation (79.7 % vs 80.9 %) or cumulative ambulatory score on discharge (2.5 vs 2.4). The mortality rate was equivocal at all time points between the cemented and uncemented groups (7 day (.9 % vs 1.2 %), 14 day (1.9 % vs 2.3 %), inpatient (4 % vs 5.1 %)). There was no difference in length of stay (11 vs 12 days) or discharge to home directly (21 % vs 27 %). CONCLUSION The use of cement did not have any significant difference on post op mortality, mobility or discharge destination.
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Affiliation(s)
- Joss Moore
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland.
| | - Mark Berney
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Mary Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Conor Hurson
- St Vincent's University Hospital, Dublin, Ireland
| | - Fiachra Rowan
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - May Cleary
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, Ireland
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Bacaksiz T, Akan I. The Fate of Reoperation After Proximal Femur Fracture Surgery in Elderly Population. Cureus 2023; 15:e39856. [PMID: 37404442 PMCID: PMC10314995 DOI: 10.7759/cureus.39856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION The overall complication rate after proximal femur fracture surgery is high. This study aims to define the reoperation reasons and outcomes of reoperations after proximal femur fracture surgery in elderly patients. METHODS This retrospective cohort study included patients over 75 years of age who underwent surgery for an intertrochanteric femur fracture and femoral neck fracture between 2014 and 2021. The minimum follow-up was 12 months, or until the patient was deceased. The primary outcome measure was the success of reoperation with regard to fracture type and implant. Results: A total of 89 patients required reoperation for an overall rate of 9.3% during follow-up. Infection was the leading reason for reoperation. Hemiarthroplasty (HA) for intertrochanteric fracture is associated with a high rate of infection compared with HA for femoral neck fracture. The success rate of reoperation due to postoperative infection was poor (46.3%) whereas the success rate for other implant-related complications was favorable (91.6%). Conclusion: The risk of postoperative infection after HA is significantly higher for intertrochanteric femur fractures compared to neck fractures in the elderly population. The limited success after postoperative infection should be taken into consideration in decision-making.
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Affiliation(s)
- Tayfun Bacaksiz
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University, Izmir, TUR
| | - Ihsan Akan
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
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Bourget-Murray J, Horton I, Morris J, Bureau A, Garceau S, Abdelbary H, Grammatopoulos G. Periprosthetic joint infection following hip hemiarthroplasty : factors associated with infection and treatment outcome. Bone Jt Open 2022; 3:924-932. [PMID: 36454723 PMCID: PMC9783270 DOI: 10.1302/2633-1462.312.bjo-2022-0138.r1] [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] [Indexed: 12/02/2022] Open
Abstract
AIMS The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. METHODS A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years' follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined. RESULTS A total of 1,984 HAs were performed during the study period, and 44 sustained a PJI (2.2%). Multiple logistic regression analysis revealed that a higher CCI score (odds ratio (OR) 1.56 (95% confidence interval (CI) 1.117 to 2.187); p = 0.003), peripheral vascular disease (OR 11.34 (95% CI 1.897 to 67.810); p = 0.008), cerebrovascular disease (OR 65.32 (95% CI 22.783 to 187.278); p < 0.001), diabetes (OR 4.82 (95% CI 1.903 to 12.218); p < 0.001), moderate-to-severe renal disease (OR 5.84 (95% CI 1.116 to 30.589); p = 0.037), cancer without metastasis (OR 6.42 (95% CI 1.643 to 25.006); p = 0.007), and metastatic solid tumour (OR 15.64 (95% CI 1.499 to 163.087); p = 0.022) were associated with increasing PJI risk. Upon final follow-up, 17 patients (38.6%) failed initial treatment and required further surgery for HA PJI. One-year mortality was 22.7%. Factors associated with treatment outcome included lower preoperative Hgb level (97.9 g/l (SD 11.4) vs 107.0 g/l (SD 16.1); p = 0.009), elevated CRP level (99.1 mg/l (SD 63.4) vs 56.6 mg/l (SD 47.1); p = 0.030), and type of surgery. There was lower chance of success with DAIR (42.3%) compared to revision HA (66.7%) or revision with conversion to total hip arthroplasty (100%). Early-onset PJI (≤ six weeks) was associated with a higher likelihood of treatment failure (OR 3.5 (95% CI 1.2 to 10.6); p = 0.007) along with patients treated by a non-arthroplasty surgeon (OR 2.5 (95% CI 1.2 to 5.3); p = 0.014). CONCLUSION HA PJI initially treated with DAIR is associated with poor chances of success and its value is limited. We strongly recommend consideration of a single-stage revision arthroplasty with cemented components.Cite this article: Bone Jt Open 2022;3(12):924-932.
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Affiliation(s)
| | - Isabel Horton
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jared Morris
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Antoine Bureau
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Simon Garceau
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Hesham Abdelbary
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada,Correspondence should be sent to George Grammatopoulos. E-mail:
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MUKKA S, HAILER NP, MÖLLER M, GORDON M, LAZARINIS S, ROGMARK C, ÖSTLUND O, SKÖLDENBERG O, WOLF O. Study protocol: The DAICY trial-dual versus single-antibiotic impregnated cement in primary hemiarthroplasty for femoral neck fracture-a register-based cluster-randomized crossover-controlled trial. Acta Orthop 2022; 93:794-800. [PMID: 36200646 PMCID: PMC9535850 DOI: 10.2340/17453674.2022.4819] [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: 05/17/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Older patients with a displaced femoral neck fracture (FNF) are often treated with a cemented primary hemiarthroplasty (HA). The DAICY trial investigates whether high-dose dual-impregnated antibioticloaded cement (DIAC) including gentamicin and clindamycin can reduce the risk of periprosthetic joint infection (PJI) in comparison with low-dose single-impregnated gentamicin antibiotic-loaded cement (SIAC), in patients ≥ 60 years treated with a cemented HA for a displaced FNF. STUDY DESIGN The trial is a national, multicenter, register-based, cluster-randomized, crossover trial. Patients ≥ 60 years with a non-pathological, displaced FNF (Type Garden 3-4/AO 31-B2 or B3) suitable for HA according to local guidelines are eligible for inclusion. Participating orthopedic departments will be randomized to start with either SIAC (control group) or DIAC treatment (intervention group) for 2 years. After 2 years, the study departments will then change to the other treatment arm for the remaining 2 years of the study. Approximately 7,000 patients will be included. The study is pragmatic in that the choice of implant brands, surgical approach and peri- and postoperative protocols follow the local routines of each participating department. All outcome variables will be retrieved after linkage of the study cohort to the following Swedish registers: the Fracture Register, the Arthroplasty Register, the National Patient Register and the Prescribed Drug Registry Outcome: The primary outcome will be periprosthetic joint infection of the index joint within 1 year after surgery. Secondary outcomes will be any reoperation on the index joint, mortality within 90 days and 1 year, resistance patterns of causative bacteria in cases of PJI, and health economics. Potential added value: This trial is designed to support or refute the efficacy of DIAC used in patients with a displaced FNF, potentially reducing PJI and resource allocation. Start of the trial and estimated duration - The DAICY trial started recruiting patients in January 2022 and will continue recruiting for approximately 4 years. Complete follow-up expected in 5 years.
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Affiliation(s)
- Sebastian MUKKA
- Department of Surgical and Perioperative Science (Orthopaedics), Umeå University, Umeå
| | - Nils P HAILER
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala
| | - Michael MÖLLER
- Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Swedish Fracture Register, Registercentrum Västra Götaland, Gothenburg
| | - Max GORDON
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm
| | - Stergios LAZARINIS
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala
| | - Cecilia ROGMARK
- Department of Orthopedics, Lund University, Skåne University Hospital, Malmö,Swedish Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg
| | | | - Olof SKÖLDENBERG
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm
| | - Olof WOLF
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala,Swedish Fracture Register, Registercentrum Västra Götaland, Gothenburg
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Affiliation(s)
- Frede Frihagen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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