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Factors associated with dislocation after bipolar hemiarthroplasty through an (antero-)lateral approach in elderly patients with a femoral neck fracture: a retrospective cohort study with a nested case-control subanalysis of radiographic parameters. Eur J Trauma Emerg Surg 2022; 48:3981-3987. [PMID: 35355090 PMCID: PMC9532330 DOI: 10.1007/s00068-022-01918-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] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/12/2022] [Indexed: 11/10/2022]
Abstract
Introduction Dislocations of hip hemiarthroplasty (HHA) are serious complications. The aim of the study was to identify clinical aspects and radiographic parameters of the hip that put patients at risk for dislocation after HHA for femoral neck fractures. Methods This retrospective analysis included elderly patients with a femoral neck fracture treated with a HHA. A lateral (90.7%) and an anterolateral (9.3%) approach was applied. On pelvic radiographs, a nested-controlled analysis was performed. Two control patients were matched to one patient suffering a dislocation with respect to age, sex, and body-mass-index (BMI). Results In 527 HHA, 10 dislocations (1.9%) were identified. In the dislocation group (DG), all patients were female (100% vs. 73.5%, p = 0.071). No significant differences between the DG and the control group (CG) were found with respect to age, body-mass-index (BMI), ASA Score, routine laboratory parameters, and comorbidity. Radiographic analysis revealed a smaller center edge angle (CEA, 39.0, IQR 33.0–42.5 vs. 43.0, IQR 41.0–46.0, p = 0.013), a more varus neck-shaft angle (NSA, 130.0, IQR 125.8–133.5 vs. 135.0, IQR 134.0–137.0, p = 0.011) of the contralateral side and a higher femoral head extrusion index (FHEI) in the DG (FHEI, 11.5, IQR 9.8–16.3 vs. 2.0 IQR 0.0–9.0, p = 0.003). In addition, a greater trochanteric fracture was associated with an increased likelihood for HHA dislocations (30.0% vs 6.0%, p = 0.022). Conclusion A smaller radiographic center edge angle, a more varus neck-shaft angle of the contralateral side, a higher femoral head extrusion index and intraoperative fractures of the greater trochanter are associated with an increased risk of HHA dislocation.
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Rotini M, Farinelli L, Natalini L, De Rosa F, Politano R, Cianforlini M, Pacetti E, Procaccini R, Magrini Pasquinelli F, Gigante A. Is Dual Mobility Total Hip Arthroplasty Surgery More Aggressive than Hemiarthroplasty when Treating Femoral Neck Fracture in the Elderly? A Multicentric Retrospective Study on 302 Hips. Geriatr Orthop Surg Rehabil 2022; 13:21514593221081375. [PMID: 35237459 PMCID: PMC8883369 DOI: 10.1177/21514593221081375] [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: 11/17/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) are validated treatments for displaced femoral neck fractures (DFNFs). BHA seldomly needs conversion to THA, but the latter has higher dislocation rate in FNFs. Dual Mobility THA offers a reduced dislocation rate and eliminates the risk of conversion. This study looks for differences between BHA and DMTHA in terms of surgical time, blood loss and transfusion, dislocation rate, mortality, and thromboembolic events. Material and Methods All patients were ≥75yo. Recorded data included use of anticoagulant/antiplatelet drugs, ASA, operative time, intra-operative complications, pre/post-operative hemoglobin values, transfusions, hospitalization time, DVT/PE, glomerular filtration rate, Charlson Comorbidity Index (CCI), dislocation at 60 days, and mortality at 30 days and 6 months. A secondary analysis compared the subgroups in different age range (75–85 and ≥ 86yo). Results In the cohort of 302 DFNF (93 BHA and 209 DMTHA) differences in mean age, CCI, and ASA score were significant. Once divided by age, the subgroups resulted comparable in terms of age and CCI, with no significant difference. A significant difference in surgical times showed DMTHA being an average 12 minutes longer than BHA. Significant was the ΔHB in the DMTHA subgroup which resulted lower compared to the BHA one. Difference in mean number of post-operative transfusion were not statistically significant. Conclusions From our data, DMTHA did not lead to an increase in mortality, morbidity, bleeding, or dislocation rate when compared to BHA and could be considered as treatment of choice for DFNFs especially in healthy and active patients.
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Affiliation(s)
- Marco Rotini
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Farinelli
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Leonardo Natalini
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Federico De Rosa
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Rocco Politano
- Department of Orthopaedics and Traumatology, "Carlo Urbani" Hospital, Jesi, Italy
| | - Marco Cianforlini
- Department of Orthopaedics and Traumatology, "Carlo Urbani" Hospital, Jesi, Italy
| | - Emanuele Pacetti
- Department of Orthopaedics and Traumatology, "Carlo Urbani" Hospital, Jesi, Italy
| | - Roberto Procaccini
- Clinic of Adult and Paediatric Orthopaedic, "Umberto I" Hospital (Ospedali Riuniti di Ancona), Ancona, Italy
| | | | - Antonio Gigante
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Abstract
BACKGROUND Hip fractures are a major healthcare problem, presenting a huge challenge and burden to individuals and healthcare systems. The number of hip fractures globally is rising rapidly. The majority of hip fractures are treated surgically. This review evaluates evidence for types of arthroplasty: hemiarthroplasties (HAs), which replace part of the hip joint; and total hip arthroplasties (THAs), which replace all of it. OBJECTIVES To determine the effects of different designs, articulations, and fixation techniques of arthroplasties for treating hip fractures in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, seven other databases and one trials register in July 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing different arthroplasties for treating fragility intracapsular hip fractures in older adults. We included THAs and HAs inserted with or without cement, and comparisons between different articulations, sizes, and types of prostheses. We excluded studies of people with specific pathologies other than osteoporosis and with hip fractures resulting from high-energy trauma. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We collected data for seven outcomes: activities of daily living, functional status, health-related quality of life, mobility (all early: within four months of surgery), early mortality and at 12 months after surgery, delirium, and unplanned return to theatre at the end of follow-up. MAIN RESULTS We included 58 studies (50 RCTs, 8 quasi-RCTs) with 10,654 participants with 10,662 fractures. All studies reported intracapsular fractures, except one study of extracapsular fractures. The mean age of participants in the studies ranged from 63 years to 87 years, and 71% were women. We report here the findings of three comparisons that represent the most substantial body of evidence in the review. Other comparisons were also reported, but with many fewer participants. All studies had unclear risks of bias in at least one domain and were at high risk of detection bias. We downgraded the certainty of many outcomes for imprecision, and for risks of bias where sensitivity analysis indicated that bias sometimes influenced the size or direction of the effect estimate. HA: cemented versus uncemented (17 studies, 3644 participants) There was moderate-certainty evidence of a benefit with cemented HA consistent with clinically small to large differences in health-related quality of life (HRQoL) (standardised mean difference (SMD) 0.20, 95% CI 0.07 to 0.34; 3 studies, 1122 participants), and reduction in the risk of mortality at 12 months (RR 0.86, 95% CI 0.78 to 0.96; 15 studies, 3727 participants). We found moderate-certainty evidence of little or no difference in performance of activities of daily living (ADL) (SMD -0.03, 95% CI -0.21 to 0.16; 4 studies, 1275 participants), and independent mobility (RR 1.04, 95% CI 0.95 to 1.14; 3 studies, 980 participants). We found low-certainty evidence of little or no difference in delirium (RR 1.06, 95% CI 0.55 to 2.06; 2 studies, 800 participants), early mortality (RR 0.95, 95% CI 0.80 to 1.13; 12 studies, 3136 participants) or unplanned return to theatre (RR 0.70, 95% CI 0.45 to 1.10; 6 studies, 2336 participants). For functional status, there was very low-certainty evidence showing no clinically important differences. The risks of most adverse events were similar. However, cemented HAs led to less periprosthetic fractures intraoperatively (RR 0.20, 95% CI 0.08 to 0.46; 7 studies, 1669 participants) and postoperatively (RR 0.29, 95% CI 0.14 to 0.57; 6 studies, 2819 participants), but had a higher risk of pulmonary embolus (RR 3.56, 95% CI 1.26 to 10.11, 6 studies, 2499 participants). Bipolar HA versus unipolar HA (13 studies, 1499 participants) We found low-certainty evidence of little or no difference between bipolar and unipolar HAs in early mortality (RR 0.94, 95% CI 0.54 to 1.64; 4 studies, 573 participants) and 12-month mortality (RR 1.17, 95% CI 0.89 to 1.53; 8 studies, 839 participants). We are unsure of the effect for delirium, HRQoL, and unplanned return to theatre, which all indicated little or no difference between articulation, because the certainty of the evidence was very low. No studies reported on early ADL, functional status and mobility. The overall risk of adverse events was similar. The absolute risk of dislocation was low (approximately 1.6%) and there was no evidence of any difference between treatments. THA versus HA (17 studies, 3232 participants) The difference in the risk of mortality at 12 months was consistent with clinically relevant benefits and harms (RR 1.00, 95% CI 0.83 to 1.22; 11 studies, 2667 participants; moderate-certainty evidence). There was no evidence of a difference in unplanned return to theatre, but this effect estimate includes clinically relevant benefits of THA (RR 0.63, 95% CI 0.37 to 1.07, favours THA; 10 studies, 2594 participants; low-certainty evidence). We found low-certainty evidence of little or no difference between THA and HA in delirium (RR 1.41, 95% CI 0.60 to 3.33; 2 studies, 357 participants), and mobility (MD -0.40, 95% CI -0.96 to 0.16, favours THA; 1 study, 83 participants). We are unsure of the effect for early functional status, ADL, HRQoL, and mortality, which indicated little or no difference between interventions, because the certainty of the evidence was very low. The overall risks of adverse events were similar. There was an increased risk of dislocation with THA (RR 1.96, 95% CI 1.17 to 3.27; 12 studies, 2719 participants) and no evidence of a difference in deep infection. AUTHORS' CONCLUSIONS For people undergoing HA for intracapsular hip fracture, it is likely that a cemented prosthesis will yield an improved global outcome, particularly in terms of HRQoL and mortality. There is no evidence to suggest a bipolar HA is superior to a unipolar prosthesis. Any benefit of THA compared with hemiarthroplasty is likely to be small and not clinically appreciable. We encourage researchers to focus on alternative implants in current clinical practice, such as dual-mobility bearings, for which there is limited available evidence.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Richard Macey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Martyn J Parker
- Department of Orthopaedics, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Xavier L Griffin
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
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Outcomes and survival of a modern dual mobility cup and uncemented collared stem in displaced femoral neck fractures at a minimum 5-year follow-up. Orthop Traumatol Surg Res 2022; 108:103164. [PMID: 34863956 DOI: 10.1016/j.otsr.2021.103164] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/02/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The choice of implant type for total hip replacement in the treatment of femoral neck fractures remains debated. Some authors advocate for the systematic use of cemented stems, while others do not use dual mobility first-line. We therefore conducted a retrospective study using a dual mobility cup (DMC) and an uncemented collared stem (UCS) in order to: (1) confirm the low dislocation rate in this indication, (2) assess other surgical complications, in particular periprosthetic fractures, (3) ensure that these benefits are maintained over time, at a minimum follow-up of 5 years and, (4) assess the rate of revision of the implants. HYPOTHESIS Our hypothesis was that the dual mobility dislocation rate for the treatment of femoral neck fractures was lower than for bipolar hemiarthroplasties or single mobility hip prostheses. PATIENTS AND METHODS A retrospective study of 244 femoral neck fractures (242 patients) treated with DMC and UCS was conducted, between 2013 and 2014. The mean age was 83±10 years (60-104). The occurrence of dislocation, periprosthetic fracture, infection of the surgical site, loosening, reoperation and revision were investigated. The HOOS Joint Replacement (JR) score was collected. The cumulative incidence with mortality was used as a competing risk. RESULTS The mean follow-up was 6 years±0.5 (5-7). At the last follow-up, 108 patients (50%) had died. Twenty-three patients (9.5%) were lost to follow-up. One case of symptomatic aseptic loosening of DMC was observed. The cumulative incidence of dislocations and periprosthetic fractures at 5 years were 2% (95% CI: 0.9-5.4) and 3% (95% CI: 1.2-6), respectively. The 5-year cumulative incidence of surgical site infections was 3.5% (95% CI: 1.8-7). The cumulative incidence of reoperations at 5 years was 7% (95% CI: 4.5-11). The causes of reoperation were periprosthetic fracture (n=6), infection (n=8), postoperative hematoma (n=2) and cup malposition (n=2). The cumulative incidence of a revision at 5 years was 2.7% (95% CI: 1.2-6). The cumulative incidence of a surgical complication from any cause at 5 years was 9% (95% CI: 6.7-14.8). The mean HOOS JR score was 79±5 (52-92). DISCUSSION The cumulative incidence of dislocation at 5 years is low and other surgical complications (including periprosthetic fractures) do not increase during this period for DMC associated with UCS, in femoral neck fractures. The use of this type of implant is reliable in the treatment of femoral neck fractures. LEVEL OF EVIDENCE IV; retrospective study without control group.
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Pollard TG, Wang KY, Fassihi SC, Gu A, Farley B, Ramamurti P, DeBritz JN, Golladay G, Thakkar SC. Does Prior Lumbar Fusion Influence Dislocation Risk in Hip Arthroplasty Performed for Femoral Neck Fracture? J Arthroplasty 2022; 37:62-68. [PMID: 34592357 DOI: 10.1016/j.arth.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Immobility of the lumbar spine predicts instability following elective total hip arthroplasty (THA). The purpose of this study is to determine how prior lumbar fusion (LF) influenced dislocation rates and revision rates for patients undergoing THA or hemiarthroplasty (HA) for femoral neck fracture (FNF). METHODS A retrospective cohort analysis was conducted utilizing the PearlDiver database from 2010 to 2018. Patients who underwent arthroplasty for FNF were identified based on history of LF and whether they underwent THA or HA. Univariate and multivariate analyses were performed. RESULTS A total of 328 patients with prior LF and FNF who underwent THA were at increased risk for 1-year dislocation (odds ratio [OR] 2.19, P < .001) and 2-year revision (OR 2.22, P < .001) compared to 14,217 patients without LF. The 461 patients with prior LF and FNF who underwent HA were at increased risk for dislocation (OR 2.22, P < .001) compared to 42,327 patients without LF. Patients with prior LF and FNF who underwent THA had higher rates of revision than patients with prior LF who underwent HA for FNF (OR 2.11, P < .001). In patients with prior LF and FNF, THA was associated with significantly increased risk for dislocation (OR 3.07, P < .001) and revision (OR 2.53, P < .001) compared to THA performed for osteoarthritis. CONCLUSION Patients with prior LF who sustained an FNF and underwent THA or HA were at increased risk for early dislocation and revision compared to those without prior LF. This risk of dislocation and revision is even greater than that observed in patients with prior LF who underwent THA for osteoarthritis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tom G Pollard
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Kevin Y Wang
- Johns Hopkins, Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD
| | - Safa C Fassihi
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Benjamin Farley
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville VA, USA
| | - James N DeBritz
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Gregory Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Savyasachi C Thakkar
- Johns Hopkins, Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD
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Cecere AB, De Cicco A, Bruno G, Toro G, Errico G, Braile A, Schiavone Panni A. SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case-control study. Arch Orthop Trauma Surg 2022; 142:3265-3270. [PMID: 34482424 PMCID: PMC9522763 DOI: 10.1007/s00402-021-04153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. MATERIALS AND METHODS We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. RESULTS Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). CONCLUSIONS The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes.
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Affiliation(s)
- Antonio Benedetto Cecere
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Gaetano Bruno
- Unit of Orthopaedics and Traumatology, AORN Sant'Anna E San Sebastiano, Caserta, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy.
| | - Giacomo Errico
- Unit of Orthopaedics and Traumatology, AORN Sant'Anna E San Sebastiano, Caserta, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
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Wek C, Reichert I, Gee M, Foley R, Ahluwalia R. Have advances in surgical implants and techniques in hemiarthroplasty for intracapsular hip fractures improved patient outcomes compared to THA? A systematic review and meta-analysis of the evidence. Surgeon 2022; 20:e344-e354. [DOI: 10.1016/j.surge.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
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Gill JR, Pathan A, Parsons SJ, Wronka K. Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship. Cureus 2021; 13:e20492. [PMID: 35047304 PMCID: PMC8760020 DOI: 10.7759/cureus.20492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
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Yoo JI, Jang SY, Cha Y, Choy WS, Koo KH. Comparison of Mortality, Length of Hospital Stay and Transfusion between Hemiarthroplasty and Total Hip Arthroplasty in Octo- and Nonagenarian Patients with Femoral Neck Fracture: a Nationwide Study in Korea. J Korean Med Sci 2021; 36:e300. [PMID: 34811975 PMCID: PMC8608921 DOI: 10.3346/jkms.2021.36.e300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the mortality rate between patients undergoing hemiarthroplasty (HA) and those undergoing total hip arthroplasty (THA) in two age groups: patients aged 65-79 years (non-octogenerian) and patients aged ≥ 80 years (octogenarian). METHODS We identified elderly (aged ≥ 65 years) femoral neck fracture patients who underwent primary THA or HA from January 1, 2005 to December 31, 2015 in South Korea using the Health Insurance and Review and Assessment database; the nationwide medical claim system of South Korea. We separately compared the mortality rate between the HA group and THA group in two age groups. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to calculate the adjusted risk ratio (aRR) of death according to the type of surgery. RESULTS The 3,015 HA patients and 213 THA patients in younger elderly group, and 2,989 HA patients and 96 THA patients in older elderly group were included. In the younger elderly group, the mortality rates were similar between the two groups. In older elderly group, the aRR of death in the THA group compared to the HA group was 2.16 (95% confidence interval [CI], 1.20-3.87; P = 0.010) within the in-hospital period, 3.57 (95% CI, 2.00-6.40; P < 0.001) within 30-days, and 1.96 (95% CI, 1.21-3.18; P = 0.006) within 60-days. CONCLUSIONS In patients older than 80 years, THA was associated with higher postoperative mortality compared to HA. We recommend the use of HA rather than THA in these patients.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Hayden BL, Varady NH, Abdeen A, Lozano-Calderon SA, Chen AF, Ready JE. No Difference Between Hemiarthroplasty and Total Hip Arthroplasty in the Treatment of Pathologic Femoral Neck Fractures. J Arthroplasty 2021; 36:3662-3666. [PMID: 34419316 DOI: 10.1016/j.arth.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) and total hip arthroplasty (THA) have been widely discussed as treatment options for displaced osteoporotic femoral neck fractures. Pathologic femoral neck fractures from primary or metastatic tumors are comparatively rare and poorly investigated. The purpose of this study was to compare outcomes, complications, and perioperative survival for HA and THA in the treatment of pathologic femoral neck fractures of neoplastic etiology. METHODS A multicenter retrospective cohort study identified patients with pathologic femoral neck fractures treated with HA or THA from 2005 to 2018. Demographics, American Society of Anesthesiologists classification, Charlson comorbidity index, Dorr classification, histopathologic diagnosis, and surgical data were compared. The primary outcome was reoperation. Secondary outcomes included 90-day mortality, estimated blood loss, length of stay, periprosthetic fracture, periprosthetic joint infection, and Eastern Cooperative Oncology Group performance status. RESULTS There were 116 patients with HA and 48 patients with THA, with no differences between groups with regard to American Society of Anesthesiologists classification, Charlson comorbidity index, or Dorr classification. There were no differences between HA and THA in the primary outcome of reoperation (5.2% vs 4.2%, P = 1.00) or secondary outcomes of perioperative 90-day overall mortality (30.2% vs 25.0%, P = .51), estimated blood loss, transfusion rates, length of stay, discharge location, periprosthetic joint infection, periprosthetic fracture, or preoperative or postoperative Eastern Cooperative Oncology Group performance status. CONCLUSIONS Both HA and THA are viable options for the treatment of patients with pathologic femoral neck fractures and demonstrated no differences in reoperations, complications, perioperative 90-day mortality, or functional outcome scores. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Brett L Hayden
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
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Thomas JC, Haidukewych GJ. Total Hip Arthroplasty for Acute Femoral Neck Fractures: Who Should Perform the Operation-Adult Reconstructive or Trauma Surgeons? J Orthop Trauma 2021; 35:606-611. [PMID: 34050073 DOI: 10.1097/bot.0000000000002091] [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] [Accepted: 02/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the results and complications of a large consecutive series of total hip arthroplasty (THA) performed for acute femoral neck (FN) fracture by adult reconstructive (AR) and trauma (T) surgeons to determine if there is a difference in outcomes. DESIGN Retrospective chart review. SETTING Level 1 trauma center. PATIENTS One hundred forty-nine consecutive patients who presented to our institution with displaced FN fractures treated by THA were included in this study. INTERVENTION All patients were treated with THA. MAIN OUTCOME MEASUREMENTS Implant survival, 90-day complications, 90-day readmission, 1-year complications. RESULTS For the group as a whole, the major surgical complication rate (defined as dislocation, deep infection, loosening, fracture) was significantly higher for T surgeons (20%) than for AR surgeons (7%) (P = 0.021). AR surgeons had significantly less radiographic component malpositioning 12% versus 3% (P = 0.024). Mortality and readmission rates were similar between the 2 cohorts at all time points. Implant survivorship was significantly higher at 1 year for AR surgeons (P = 0.05). CONCLUSIONS THA for acute FN fracture performed by AR surgeons demonstrated higher rates of accurate radiographic component positioning, significantly lower major complication rates at 90 days and 1 year, and greater implant survival at 1 year. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Gray Stephens CE, Ashaye OJ, Ellenbogen TD, Sexton SA, Middleton RG. Dual Mobility hip replacement in hip fractures offer functional equivalence and a stability advantage - A case-controlled study. Injury 2021; 52:3017-3021. [PMID: 33518294 DOI: 10.1016/j.injury.2021.01.027] [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: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fracture is a common and serious injury in the elderly. Hip arthroplasty is the most frequently performed procedure for patients with an intracapsular hip fracture. The majority of national guidelines recommend total hip arthroplasty (THA) for more active patients. Literature indicates significant stability advantages for dual mobility (DM) acetabular components in non-emergent scenarios. Evidence supporting the use of DM in hip fracture patients is limited. AIM We set out to ascertain if DM implants offer stability and/or functional advantages over standard THA in patients with hip fracture. METHODS We utilised our local National Hip Fracture Database to identify all patients undergoing either a standard or DM THA for hip fracture (n=477) We matched cohorts based on age, AMTS, mobility status pre-operatively, gender, ASA and source of admission. Our primary outcome of interest was functional status using the oxford hip score (OHS). Secondary outcome measures included dislocation, fracture and deep infection requiring further surgery. RESULTS 62 patient pairs were available for this study. Mean OHS for DM THA was 41.5 and for standard THA this was 42.7 (p=0.58). There were 4 dislocations in the standard THA group and 0 with DM THA. No difference was seen with infection or peri-prosthetic fracture. CONCLUSION This study demonstrates functional equivalence between DM and standard THA. In addition it shows a trend towards less dislocation with DM THA. Cost savings from less instability may outweigh initial prosthesis costs. This study suggests a suitably powered RCT using instability as the primary outcome measure is indicated.
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Huddleston JI, De A, Jaffri H, Barrington JW, Duwelius PJ, Springer BD. Cementless Fixation Is Associated With Increased Risk of Early and All-Time Revision After Hemiarthroplasty But Not After THA for Femoral Neck Fracture: Results From the American Joint Replacement Registry. Clin Orthop Relat Res 2021; 479:2194-2202. [PMID: 34398846 PMCID: PMC8445546 DOI: 10.1097/corr.0000000000001932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite ample evidence supporting cemented femoral fixation for both hemiarthroplasty and THA for surgical treatment of displaced femoral neck fractures, cementless fixation is the preferred fixation method in the United States. To our knowledge, no nationally representative registry from the United States has compared revision rates by fixation for this surgical treatment. QUESTION/PURPOSE After controlling for relevant confounding variables, is femoral fixation method (cemented or cementless) in hemiarthroplasty or THA for femoral neck fracture associated with a greater risk of (1) all-cause revision or (2) revision for periprosthetic fracture? METHODS Patients with Medicare insurance who had femoral neck fractures treated with hemiarthroplasty or THA reported in the American Joint Replacement Registry database from 2012 to 2017 and Centers for Medicare and Medicaid Services claims data from 2012 to 2017 were analyzed in this retrospective, large-database study. Of the 37,201 hemiarthroplasties, 42% (15,748) used cemented fixation and 58% (21,453) used cementless fixation. Of the 7732 THAs, 20% (1511) used cemented stem fixation and 80% (6221) used cementless stem fixation. For both the hemiarthroplasty and THA cohorts, most patients were women and had cementless femoral fixation. Early revision was defined as a procedure that occurred less than 90 days from the index procedure. All patients submitted to the registry were included in the analysis. Patient follow-up was limited to the study period. No patients were lost to follow-up. Due to inherent limitations with the registry, we did not compare medical complications, including deaths attributed directly to cemented fixation. A logistic regression model including the index arthroplasty, age, gender, stem fixation method, hospital size, hospital teaching affiliation, and Charlson comorbidity index score was used to determine associations between the index procedure and revision rates. RESULTS For the hemiarthroplasty cohort, risk factors for any revision were cementless stem fixation (odds ratio 1.42 [95% confidence interval 1.20 to 1.68]; p < 0.001), younger age (OR 0.96 [95% CI 0.95 to 0.97]; p < 0.001), and higher Charlson comorbidity index (OR 1.06 [95% CI 1.02 to 1.11]; p = 0.004). Risk factors for early revision were cementless stem fixation (OR 1.77 [95% CI 1.43 to 2.20]; p < 0.001), younger age (OR 0.98 [95% CI 0.97 to 0.99]; p < 0.001), and higher Charlson comorbidity index (OR 1.09 [95% CI 1.04 to 1.15]; p < 0.001). Risk factors for revision due to periprosthetic fracture were cementless fixation (OR 6.19 [95% CI 3.08 to 12.42]; p < 0.001) and higher Charlson comorbidity index (OR 1.16 [95% CI 1.06 to 1.28]; p = 0.002). Risk factors for early revision due to periprosthetic fracture were cementless fixation (OR 7.38 [95% CI 3.17 to 17.17]; p < 0.001), major teaching hospital (OR 2.10 [95% CI 1.08 to 4.10]; p = 0.03), and higher Charlson comorbidity index (OR 1.20 [95% CI 1.09 to 1.33]; p < 0.001). For the THA cohort, there were no associations. CONCLUSION These data suggest that cemented fixation should be the preferred technique for most patients with displaced femoral neck fractures treated with hemiarthroplasty. The fact that stem fixation method did not affect revision rates for those patients with displaced femoral neck fractures treated with THA may be due to current practice patterns in the United States. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | - Ayushmita De
- American Academy of Orthopaedic Surgeons, Rosemont, IL, USA
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Rosemont, IL, USA
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Abstract
ABSTRACT Hip fractures are considered a significant public health issue, representing a substantial burden on our healthcare system and society. They are one of the leading causes of disability among older adults, especially women. Globally, an estimated 18% of women and 6% of men will be affected by hip fractures at some time in life. Hip fractures are a major cause of long-term disability among older adults and more significant than mortality, as only 60% of patients regain their preinjury level of mobility. This has detrimental effects on quality of life and activities of daily living, imposing a level of dependence that has personal, social, and systemic consequences.
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Affiliation(s)
- Meagan L Barry
- At the time this article was written, Meagan L. Barry was a student in the PA program at the University of Tennessee Health Science Center in Memphis. She now practices at Dallas (Tx.) Orthopaedic Joint Institute. Kristopher R. Maday is an associate professor and program director in the PA program at the University of Tennessee. The authors have disclosed no potential conflicts of interest, financial or otherwise
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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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Fletcher JWA, Sommer C, Eckardt H, Knobe M, Gueorguiev B, Stoffel K. Intracapsular Femoral Neck Fractures-A Surgical Management Algorithm. ACTA ACUST UNITED AC 2021; 57:medicina57080791. [PMID: 34440996 PMCID: PMC8400014 DOI: 10.3390/medicina57080791] [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] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/04/2023]
Abstract
Background and Objectives: Femoral neck fractures are common and constitute one of the largest healthcare burdens of the modern age. Fractures within the joint capsule (intracapsular) provide a specific surgical challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Most femoral neck fractures are treated surgically, aiming to maintain mobility, whilst reducing pain and complications associated with prolonged bedrest. Materials and Methods: We performed a narrative review of intracapsular hip fracture management, highlighting the latest advancements in fixation techniques, generating an evidence-based algorithm for their management. Results: Multiple different fracture configurations are encountered within the category of intracapsular hip fractures, with each pattern having different optimal surgical strategies. Additionally, these injuries typically occur in patients where further procedures due to operative complications are associated with a considerable increase in mortality, highlighting the need for choosing the correct index operation. Conclusions: Factors such as pathological causes for the fracture, pre-existing symptomatic osteoarthritis, patient’s physiological age and fracture displacement all need to be considered when choosing optimal management.
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Affiliation(s)
- James W. A. Fletcher
- AO Research Institute Davos, 7270 Davos, Switzerland;
- Department for Health, University of Bath, Bath BA2 7AY, UK
- Correspondence:
| | | | - Henrik Eckardt
- University Hospital Basel, 4052 Basel, Switzerland; (H.E.); (K.S.)
| | - Matthias Knobe
- Department of Orthopaedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
| | | | - Karl Stoffel
- University Hospital Basel, 4052 Basel, Switzerland; (H.E.); (K.S.)
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Total Hip Arthroplasty for Femoral Neck Fracture: What Are the Contemporary Reasons for Failure? J Arthroplasty 2021; 36:S272-S276. [PMID: 33736895 DOI: 10.1016/j.arth.2021.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) for femoral neck fracture (FNF) appears to provide superior functional outcomes compared to hemiarthroplasty in selected active, elderly patients; however, the historical tradeoff has been higher risk of complications including dislocation. We aimed to describe implant survivorship and reasons for failure after THA for FNFs. METHODS We identified 217 FNFs treated with THA from 2000 to 2017 from our institutional total joint registry (during the same time period 2039 FNFs were treated with hemiarthroplasty). Mean age was 70 years, and 65% were female. Cemented femoral components were utilized in 41%. Approach was anterolateral in 71%, posterior in 21%, and direct anterior in 8%. Dual-mobility constructs were utilized in 3%. A competing risk model accounting for death was used to analyze revisions and complications. Mean follow-up was 6 years. RESULTS The 5-year cumulative incidence of any revision was 8%. Nineteen hips were revised for the following indications: postoperative periprosthetic femur fracture (6: 3 uncemented stems and 3 cemented), infection (5), aseptic loosening of the femoral component (3: 2 cemented and 1 uncemented), dislocation (3), iliopsoas impingement (1), and liner dissociation (1). The 5-year cumulative incidence of periprosthetic femur fractures was 7%, including 7 intraoperative fractures and 11 postoperative fractures. The 5-year cumulative incidence of dislocation was 1.4%. CONCLUSION The 5-year cumulative incidence of any revision after THA for FNFs was 8%, mostly attributed to periprosthetic fracture and infection. Hip instability was not as common after FNF with contemporary patient selection, techniques, and implants compared to previous series. LEVEL OF EVIDENCE Prognostic, level III.
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Lin X, Yang K, Tan H, Gan F, Jiang J. Comparison of the Curative Effects of Hip Arthroplasty with Bio-Type Femoral Stem and Cemented Femoral Stem in Elderly Patients with Unstable Osteoporotic Intertrochanteric Femur Fractures. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dual-Mobility Articulations in Femoral Neck Fractures: A Systematic Review of the Literature and Meta-analysis of the Outcomes. J Am Acad Orthop Surg 2021; 29:e618-e627. [PMID: 32925381 DOI: 10.5435/jaaos-d-20-00407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/24/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Femoral neck fractures have been traditionally managed with hemiarthroplasty (HA) or conventional total hip arthroplasty (CTHA). There has been recent interest in using dual-mobility components (DMC) in total hip arthroplasty for patients with femoral neck fractures to provide increased stability and decrease the need for future revision. METHODS We conducted a systematic review of the literature reporting on the use of DMC in the management of femoral neck fractures in geriatric patients. We included studies in which DMC were used alone and studies that included a comparison to total hip arthroplasty or HA. The outcomes of interest were postoperative dislocation, revision, and revision surgery rates. Two separate subgroup analyses were conducted. For the comparative studies, we analyzed the differences in outcomes using a random-effects model of relative risks. For the noncomparative studies, we estimated the cumulative incidence of the different outcomes. RESULTS Eighteen studies met the inclusion criteria and were included in our analysis. Eleven noncomparative studies showed a cumulative incidence of dislocation to be 1.2% (95% confidence interval = 0.3% to 2.7%) when DMC were used alone. Subgroup analyses of the seven comparative studies yielded a relative risk of dislocation using DMC was 59% less than HA and 83% less than CTHA. DMC also compared favorably in terms of revision surgery and revision rates to HA. There was insufficient quality evidence to comment on revision surgery and revision rates when compared with CTHA in comparative studies, but among the noncomparative studies, there was a low rate of revision and revision surgery. CONCLUSIONS Our study revealed overall lower risk of dislocation using DMC compared with both CTHA and HA. There were also lower revision and revision surgery rates when DMC were used compared with HA. Further studies are required to elucidate cost-effectiveness and long-term outcomes of DMC in these scenarios. LEVEL OF EVIDENCE Level III-meta-analysis.
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Boddapati V, Held MB, Levitsky M, Charette RS, Neuwirth AL, Geller JA. Risks and Complications After Arthroplasty for Pathological or Impending Pathological Fracture of the Hip. J Arthroplasty 2021; 36:2049-2054.e5. [PMID: 33640182 DOI: 10.1016/j.arth.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Treatment options for metastatic osseous lesions of the proximal femur include hemiarthroplasty (HA) or total hip arthroplasty (THA) depending on lesion characteristics and patient demographics. Studies assessing short-term outcomes after HA/THA in this patient population are limited. Therefore, the purpose of this present study was to identify short-term rates of morbidity and mortality after HA/THA for pathological proximal femur fractures, as well as readmission and reoperation rates and reasons. METHODS This study utilized a large, prospectively collected registry to identify patients who underwent HA/THA between 2011 and 2018. Patients were stratified by indication for surgery, including pathological fracture, nonpathological fracture, and osteoarthritis. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis. RESULTS In total, 883 patients undergoing HA/THA for a pathological fracture were identified. Relative to an osteoarthritis cohort, these patients tended to be older, had a lower body mass index, and had significantly more preoperative comorbidities. These patients had high rates of total complications (13.93%), including thirty-day mortality (3.29%), unplanned return to the operating room (4.98%), and pulmonary complications (3.85%). Patients with pathological fracture had a longer operative duration relative to osteoarthritis and nonpathological cohorts (+27 and +25 minutes, respectively), despite having high rates of HAs performed. CONCLUSION Patients undergoing hip arthroplasty for pathologic proximal femur fracture have increased morbidity and mortality relative to an osteoarthritis cohort. However, patients with a pathological fracture have similar rates of morbidity and mortality when compared with a nonpathological fracture cohort, but did experience higher rates of perioperative blood transfusion and unplanned readmissions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Venkat Boddapati
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Michael B Held
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Matthew Levitsky
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ryan S Charette
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Alexander L Neuwirth
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Jeffrey A Geller
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
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Haider T, Seilern Und Aspang J, Gahleitner C, Plesser S, Hajdu S. Does patient positioning influence blood loss and transfusion rate in hip replacement for femoral neck fractures? A single-centre, retrospective chart review. BMC Musculoskelet Disord 2021; 22:496. [PMID: 34049508 PMCID: PMC8164291 DOI: 10.1186/s12891-021-04375-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/11/2021] [Indexed: 01/28/2023] Open
Abstract
Background We compared blood loss and transfusion frequency between the lateral decubitus and the supine position in patients undergoing hip replacement surgery due to femoral neck fractures. Methods We retrospectively included femoral neck fracture patients treated with either hemi (HA) or total hip arthroplasty (THA). We included a total of 626 patients, of which 313 patients underwent surgery in the lateral decubitus position and 313 patients in the supine position. Preoperative and day 1 postoperative blood measures including hemoglobin (Hb), hematocrit (Hct), and red blood cell count (RBC) were evaluated, as well as transfusion records analyzed. Results The following decrease of laboratory parameters between pre- and 1st day postoperative measures was noted: RBC: -0.77 G/L (± 0.5 G/L, median = -0.80 G/L; range: -0.50 – -1.10 G/L); Hct: -7.08 % (± 4.7 %, range: -4.70 – -9.90 G/L); Hb: -2.36 g/dL (± 1.6 g/dL, range: -1.50. – -3.40 g/dL). We did not observe significant differences in transfusion frequency between the two study cohorts (p = 0.735 for THA, p = 0.273 for HA). No influence of patient positioning on Hb-decrease, Hct-decrease, or RBC-decrease was noted in our two-way ANOVA models with consideration of implant type and fixation technique (F(3,618) = 1.838, p = 0.139; F(3,618) = 2.606, p = 0.051; F(3,618) = 1.407, p = 0.240). Conclusions We did not observe significant differences in perioperative blood values and transfusion rates in association with patient positioning in patients undergoing hip replacement surgery for femoral neck fractures. Level of evidence Level III, retrospective cohort study.
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Affiliation(s)
- Thomas Haider
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Jesse Seilern Und Aspang
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Claudia Gahleitner
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Stefan Plesser
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Ma HH, Chou TFA, Pai FY, Tsai SW, Chen CF, Wu PK, Chen WM. Outcomes of dual-mobility total hip arthroplasty versus bipolar hemiarthroplasty for patients with femoral neck fractures: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:152. [PMID: 33627151 PMCID: PMC7903652 DOI: 10.1186/s13018-021-02316-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Elderly patients with femoral neck fractures are at a higher risk of dislocation after hip arthroplasty procedures. In comparison with total hip arthroplasty (THA), bipolar hemiarthroplasty (HA) and dual-mobility total hip arthroplasty (DM-THA) can be an effective alternative treatment which increases the effective head size and overall stability of the prosthesis. We aim to review the current evidence on the outcome after DM-THA and HA for femoral neck fractures in the elderly. Methods We performed a comprehensive review of literatures on PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials and comparative interventional studies. Of the 936 studies identified, 8 met the inclusion criteria (541 DM-THA and 603 HA procedures). Two reviewers independently reviewed and graded each study and recorded relevant data including dislocation rate, implant failure rate, reoperation rate, 1-year mortality rate, Harris hip score (HHS), operation time, and intraoperative blood loss. Results DM-THA was associated with a lower dislocation rate (OR 3.599; 95% CI 1.954 to 6.630), a lower reoperation rate (OR 2.056; 95% CI 1.211 to 3.490), an increased operation time (SMD − 0.561; 95% CI − 0.795 to − 0.326) and more intraoperative blood loss (SMD − 0.778; 95% CI − 1.238 to − 0.319), compared with the HA group. Moreover, the multivariate regression analysis revealed that age, female sex, posterolateral surgical approach, and choice of DM-THA or HA were not associated with dislocation or reoperation. Conclusions Based on the current evidence, the advantages reported for DM-THA over HA with regard to dislocation and reoperation rate in elderly patients with FNF remain inconclusive. High-quality studies on the high-risk patients with cognitive disorder or dementia are necessary to validate the value of DM-THA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02316-6.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Yuan Pai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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鲁 攀, 谢 添, 代 广, 李 荥, 邹 继, 陈 辉, 芮 云. [Risk factors analysis for postoperative mortality of elderly patients with femoral neck fracture undergoing hemiarthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:217-220. [PMID: 33624477 PMCID: PMC8171678 DOI: 10.7507/1002-1892.202009122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty. METHODS Patients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality. RESULTS The 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty ( P<0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality ( P<0.05). CONCLUSION To improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.
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Affiliation(s)
- 攀攀 鲁
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 添 谢
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 广春 代
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 荥娟 李
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 继红 邹
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 辉 陈
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 云峰 芮
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
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Peng L, Liu H, Hu X, Liu J. Hemiarthroplasty versus total hip arthroplasty for displaced femoral neck fracture in patients older than 80 years: A randomized trial protocol. Medicine (Baltimore) 2020; 99:e23530. [PMID: 33327300 PMCID: PMC7738070 DOI: 10.1097/md.0000000000023530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The forms of treatment which are available for these patients include internal fixation, hemiarthroplasty (HA), or total hip arthroplasty (THA). Both HA and THA are widely used methods of hip replacement after displaced femoral neck fracture (DFNF). Our purpose is to analyze the long-term outcomes of these 2 different forms of treatment, which are suitable for active patients with femoral neck intracapsular fractures ≥80 years of age without advanced osteoarthritis or rheumatoid arthritis. METHODS This study is designed as a single-center randomized controlled trial. The participants will be randomly assigned to either the THA group or the HA group. Information will be collected from all participants after obtaining written informed consent in accordance with the Declaration of Helsinki and ethical board approval. Inclusion criteria include: displaced intracapsular femoral neck fracture, capability to obtain informed consent, no known metastatic disease, no contraindications to anesthesia, age ≥80 years, and ability to understand written Chinese. Patients will be evaluated at 3 months, 6 months, 1 year, and 3 years after surgery. At the time of the final follow-up, patients were assessed with use of the Harris hip score (HHS) and walking distance. Secondary outcomes of interest include postoperative complications, including 90-day medical complications (acute myocardial infarction, deep vein thrombosis, pulmonary embolism, intestinal obstruction, renal failure, and pneumonia) and surgical complications within 1 year (dislocation, infection, and revision replacement). RESULTS This trial is expected to be the largest randomized trial assessing the efficacy of THA and HA and powered to detect a potential difference in the primary outcome. TRIAL REGISTRATION This study protocol has been registered in Research Registry (researchregistry6203).
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Affiliation(s)
- Lin Peng
- Department of Orthopaedics, The Fourth People's Hospital of Jinan, The Third Affiliated Hospital of Shandong First Medical University
| | - Hongyu Liu
- Department of Orthopaedics, The Fourth People's Hospital of Jinan, The Third Affiliated Hospital of Shandong First Medical University
| | - Xiaoyi Hu
- Department of Disease Control and Prevention, PLA 960th Hospital, Shandong, China
| | - Jianqiang Liu
- Department of Orthopaedics, The Fourth People's Hospital of Jinan, The Third Affiliated Hospital of Shandong First Medical University
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75
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Tang X, Wang D, Liu Y, Chen J, Zhou Z, Li P, Ning N. The comparison between total hip arthroplasty and hemiarthroplasty in patients with femoral neck fractures: a systematic review and meta-analysis based on 25 randomized controlled trials. J Orthop Surg Res 2020; 15:596. [PMID: 33302984 PMCID: PMC7730787 DOI: 10.1186/s13018-020-02122-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023] Open
Abstract
Background We performed an updated systematic review and meta-analysis which enrolled 25 prospective randomized controlled trials (RCTs) to compare the outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs). Methods We searched English databases which included PubMed, Embase (vis OvidSP), The Cochrane Library, and Web of Science, and Chinese databases Chinese National Knowledge Infrastructure (CNKI), VIP, Wang Fang, and China Biology Medicine Disc (CBM) in July 2020. The quality of each study was assessed according to the Cochrane Collaboration’s Risk of Bias. Risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were pooled with random-effects models. Data regarding baseline characteristics, hospital and surgery outcomes, clinical outcomes, patients’ quality of life, common complications, prothesis-related complications, mortality, and costs were reported. Results A total of 25 RCTs involving 3223 patients (1568 THA and 1655 HA) were included. THA had longer hospital length (WMD = 0.721, P < 0.0001) and surgery time (WMD = 20.044, P < 0.0001), and more blood loss compared with HA (WMD = 69.109, P < 0.0001). THA showed better ratings in the Harris Hip Score during follow-up periods between 1 and 5 years while no differences within 6 months and after 9 years. THA was associated with higher quality-of-life EuroQol-5 Dimension (EQ-5D) scores after 2 years of surgery but no difference within 1 year. There was no difference in common complications. THA had significant higher rate of dislocation (WMD = 1.897, P = 0.002) and lower acetabular erosion (WMD = 0.030, P = 0.001). For mortality, there was no difference during all the follow-up periods except for slightly higher 2-year mortality after surgery. Conclusion This meta-analysis demonstrates that THA has better medium-term functional results and quality of life and lower acetabular erosion rate, while HA shows better in reducing hospital stay, surgery time, and blood loss and also has lower dislocation rate.
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Affiliation(s)
- Xiumei Tang
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Duan Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ying Liu
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jiali Chen
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Peifang Li
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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76
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Peng W, Bi N, Zheng J, Xi N. Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis. Chin J Traumatol 2020; 23:356-362. [PMID: 33289633 PMCID: PMC7718551 DOI: 10.1016/j.cjtee.2020.09.005] [Citation(s) in RCA: 5] [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: 05/20/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event. METHODS The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty", "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event. RESULTS This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up. CONCLUSION Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.
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Anderson JT, Hudyk AR, Haas AR, Ahn NU, Rothberg DL, Gililland JM. Displaced Femoral Neck Fractures in Workers' Compensation Patients Aged 45-65 Years: Is It Best to Fix the Fracture or Replace the Joint? J Arthroplasty 2020; 35:3195-3203. [PMID: 32600808 DOI: 10.1016/j.arth.2020.06.003] [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: 04/03/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimal surgical management of displaced femoral neck fractures (dFNFs) in subjects 45-65 years old is unclear. We evaluated days out of work (dOOW), medical and indemnity costs, and secondary outcomes at 2 years between internal fixation (IF), hemiarthroplasty (HA), and total hip arthroplasty (THA) among workers' compensation (WC) subjects with isolated dFNFs aged 45-65. METHODS We retrospectively identified 105 Ohio Bureau of WC subjects with isolated subcapital dFNFs aged 45-65 with 2 years of follow-up. In total, 37 (35.2%) underwent IF, 23 (21.9%) THA, and 45 (42.9%) HA from 1993 to 2017. Linear regression was used to determine if surgery type was predictive of dOOW postoperatively and to evaluate inflation-adjusted net medical and indemnity costs at 2 years. RESULTS IF subjects were younger (52.9) than THA (58.5, P < .001) and HA (58.4, P < .001) subjects. Mean dOOW for THA subjects at 6 months, 1 year, and 2 years was 90.8, 114.6, and 136.6. This was significantly lower than IF (136.3, 182.0, 236.6) and HA (114.6, 153.3, 247.6) subjects at all time points. Medical costs were similar. Mean indemnity costs were 3.0 and 2.4 times higher among IF (P < .001) and HA (P = .007) groups compared to THA, respectively. Rates of postoperative permanent disability awards were 13.0%, 43.2%, and 35.6% for the THA, IF, and HA groups (P = .050). IF and HA subjects had a 24.3% and 11.1% revision rate. Overall, 77.8% and 100% of the IF and HA revisions were conversions to THA. CONCLUSION WC subjects aged 45-65 with dFNFs treated with THA had fewer dOOW, lower indemnity costs, and less disability at 2 years. Longer follow-up will help determine the durability and long-term outcomes of these surgeries.
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Affiliation(s)
- Joshua T Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | | | | | - Nicholas U Ahn
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - David L Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Predictors of Medical Serious Adverse Events in Hip Fracture Patients Treated With Arthroplasty. J Orthop Trauma 2020; 34 Suppl 3:S42-S48. [PMID: 33027165 DOI: 10.1097/bot.0000000000001935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM Patients with hip fractures are often frail with multiple comorbidities and at risk of medical serious adverse events (SAEs). We investigated the HEALTH trial patient population to ascertain predictors of SAEs. METHODS We performed a multivariable Cox regression analysis. Occurrence of SAEs was included as the dependent variable with 31 potential prognostic factors being included as independent variables. RESULTS One thousand four hundred forty-one patients were included in this analysis. Three hundred seventy (25.6%) patients suffered from an SAE. The most common events were cardiac (38.4%, n = 105), respiratory (20.8%, n = 77), and neurological (14.1%, n = 77). The majority of SAEs (50.8%, n = 188) occurred in the first 90 days after hip fracture with 35.4% occurring in the first 30 days (n = 131). Body mass index (BMI) between 18.5 and 24.9 compared with BMI between 25 and 29.9 [hazard ratio (HR) 1.32, P = 0.03] and receiving a total hip arthroplasty compared with a bipolar hemiarthroplasty (HR 1.36, P = 0.03) were associated with a higher risk of a medical SAE within 24 months of femoral neck fracture. Age (P = 0.09), use of femoral cement (P = 0.59), and use of canal pressurization (P = 0.37) were not associated with a medical SAE. CONCLUSION Total hip arthroplasty is associated with more SAEs in the immediate postoperative period, and care should be taken in selecting patients for this treatment compared with a hemiarthroplasty. A higher BMI may be protective in hip fracture patients while age alone does not predict SAEs and neither does the use of femoral cement and/or pressurization. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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What Factors Increase Revision Surgery Risk When Treating Displaced Femoral Neck Fractures With Arthroplasty: A Secondary Analysis of the HEALTH Trial. J Orthop Trauma 2020; 34 Suppl 3:S49-S54. [PMID: 33027166 DOI: 10.1097/bot.0000000000001936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES HEALTH was a randomized controlled trial comparing total hip arthroplasty with hemiarthroplasty in low-energy displaced femoral neck fracture patients aged ≥50 years with unplanned revision surgery within 24 months of the initial procedure being the primary outcome. No significant short-term differences between treatment arms were observed. The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after hip fracture. METHODS We analyzed 9 potential factors chosen a priori that could be associated with revision surgery. The factors included age, body mass index, major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. Our statistical analysis was a multivariable Cox regression using reoperation within 24 months of index surgery as the dependent variable. RESULTS Of the 1441 patients included in this analysis, 8.1% (117/1441) experienced reoperation within 24 months. None of the studied factors were found to be predictors of revision surgery (P > 0.05). CONCLUSION Both total and partial hip replacements are successful procedures in low-energy displaced femoral neck fracture patients. We were unable to identify any patient or surgeon-controlled factors that significantly increased the need for revision surgery in our elderly and predominately female patient population. One should not generalize our findings to an active physiologically younger femoral neck fracture population. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Is Total Hip Arthroplasty a Cost-Effective Option for Management of Displaced Femoral Neck Fractures? A Trial-Based Analysis of the HEALTH Study. J Orthop Trauma 2020; 34 Suppl 3:S37-S41. [PMID: 33027164 DOI: 10.1097/bot.0000000000001932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Displaced femoral neck fractures are a significant source of morbidity and mortality and can be treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA). Proponents of THA have argued THA offers lower risk of revision, with improved functional outcomes when compared to HA. To evaluate cost effectiveness of THA compared with HA, a trial-based economic analysis of the HEALTH study was undertaken. METHODS Health care resource utilization (HRU) and health-related quality of life (HRQoL) data were collected postoperatively and costed using publicly available databases. Using EuroQol-5 Dimensions (EQ-5D) scores, we derived quality adjusted life years (QALYs). A 1.5% discount rate to both costs and QALYs was applied. Age analyses per age group were conducted. All costs are reported in 2019 Canadian dollars. RESULTS When compared with HA, THA was not cost-effective for all patients with displaced femoral neck fractures ($150,000/QALY gained). If decision makers were willing to spend $50,000 or $100,000 to gain one QALY, the probability of THA being cost-effective was 12.8% and 32.8%, respectively. In a subgroup of patients younger than 73 (first quartile), THA was both more effective and less costly. Otherwise, THA was more expensive and yielded marginal HRQoL gains. CONCLUSIONS Our results suggest that for most patients, THA is not a cost-effective treatment for displaced femoral neck fracture management versus HA. However, THA may be cost effective for younger patients. These patients experience more meaningful improvements in quality of life with less associated cost because of shorter hospital stay and fewer postoperative complications. LEVEL OF EVIDENCE Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
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What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial. J Orthop Trauma 2020; 34 Suppl 3:S29-S36. [PMID: 33027163 DOI: 10.1097/bot.0000000000001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). CONCLUSION Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. LEVEL OF EVIDENCE Prognostic Level II.
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Graulich T, Graeff P, Jaiman A, Nicolaides S, Omar Pacha T, Örgel M, Macke C, Omar M, Krettek C, Liodakis E. Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case-control study of patients with CT data. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:627-633. [PMID: 33098004 PMCID: PMC8053145 DOI: 10.1007/s00590-020-02819-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/15/2020] [Indexed: 01/07/2023]
Abstract
Purpose Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty
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Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Graeff
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ashish Jaiman
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Stine Nicolaides
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tarek Omar Pacha
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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83
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Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:587-594. [PMID: 33068165 PMCID: PMC7981295 DOI: 10.1007/s00590-020-02808-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/25/2022]
Abstract
Background The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups. Methods A prospective double-blind randomised control trial was conducted. Fifty patients with an intracapsular hip fracture meeting the inclusion criteria were randomised to either an uncemented (n = 25) or cemented (n = 25) THA. There were no differences (p > 0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months. Results The study was terminated early due to the significantly (n = 8, p = 0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p ≥ 0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p = 0.75) or blood loss (p = 0.66) between the groups. There were two early revisions prior to 3 months post-operatively in the uncemented group and none in the cemented group, but this was not significant (log rank p = 0.16). Conclusion There was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.
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84
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Ekhtiari S, Gormley J, Axelrod DE, Devji T, Bhandari M, Guyatt GH. Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Bone Joint Surg Am 2020; 102:1638-1645. [PMID: 32732709 DOI: 10.2106/jbjs.20.00226] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip fractures are a leading cause of disability worldwide, with displaced femoral neck fractures being of particular concern. A recent meta-analysis reported that total hip arthroplasty (THA) was superior to hemiarthroplasty (HA) in terms of reoperations, but inferior in terms of dislocations. However, publication of 4 additional randomized controlled trials that enrolled nearly 1,780 additional patients merits an updated meta-analysis. METHODS We conducted a literature search of 4 databases to identify randomized controlled trials comparing THA and HA in patients with displaced femoral neck fractures. For patient-reported outcomes, the minimally important difference informed calculation of risk differences. We performed a subgroup analysis to address the possible impact of risk of bias and performed meta-regression to assess the possible impact of duration of follow-up. RESULTS Sixteen studies that enrolled 3,084 patients randomized to undergo THA (n = 1,521) or HA (n = 1,563) proved eligible. There were no significant differences between the 2 groups in terms of the revision rate at up to 5 years of follow-up or functional outcome at up to 3 years. Health-related quality of life was superior in the THA group (mean difference [MD] = 0.05, 95% confidence interval [CI] = 0.02 to 0.07, minimally important difference, 0.145). There was no significant difference between the groups in terms of dislocation or periprosthetic fracture incidence. Operative time was significantly shorter in the HA group (MD = 22 minutes, 95% CI = 9 to 35 minutes). Analyses addressing risk of bias and length of follow-up did not reveal subgroup differences. Certainty of evidence for all outcomes was rated as moderate. CONCLUSIONS The best evidence showed, with moderate certainty, that HA and THA likely result in similar revision rate, function, mortality, periprosthetic fracture, and dislocation at up to 5 years, with a small, possibly unimportant benefit in health-related quality of life with THA. More specifically, the improvements are well below established cutoffs for clinical importance. Almost half of all patients were from a single large randomized controlled trial, although the results were consistent across the studies. In addition, HA likely results in a clinically unimportant reduction in operative time. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery (S.E., D.E.A., and M.B.), Department of Health Research Methods, Evidence, and Impact (T.D. and G.H.G.), and Michael G. DeGroote School of Medicine (J.G.), McMaster University, Hamilton, Ontario, Canada
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85
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Okike K. Which Form of Hip Arthroplasty Is Preferred?: Commentary on an article by Seper Ekhtiari, MD, et al.: "Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fracture. A Systematic Review and Meta-Analysis of Randomized Controlled Trials". J Bone Joint Surg Am 2020; 102:e108. [PMID: 32941245 DOI: 10.2106/jbjs.20.01054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kanu Okike
- Department of Orthopaedics, Kaiser Moanalua Medical Center, Honolulu, Hawaii
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86
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Young JR, O’Connor CM, Anoushiravani AA, DiCaprio MR. The Use of Dual Mobility Implants in Patients Who Are at High Risk for Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2020; 8:e20.00028. [DOI: 10.2106/jbjs.rvw.20.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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87
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Kenanidis E, Zagalioti SCC, Milonakis N, Tsapakis EM, Tsiridis E. A Catastrophic Cascade of Postoperative Complications Following Hemiarthroplasty for Femoral Neck Fracture in a Middle-Aged Patient With Schizophrenia. Cureus 2020; 12:e9044. [PMID: 32782863 PMCID: PMC7410513 DOI: 10.7759/cureus.9044] [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] [Indexed: 11/10/2022] Open
Abstract
The treatment of a patient with schizophrenia suffering a subcapital hip fracture may be challenging, mainly due to the high risk of postoperative medical and surgical complications. Mechanical complications from the implant are also frequently encountered following hip arthroplasty in patients with schizophrenia. We report the case of a 57-year-old male patient with schizophrenia who underwent hip hemiarthroplasty for a displaced femoral neck fracture. During the initial postoperative period, the patient developed a cascade of surgical and mechanical complications, leading to multiple revision procedures and a suboptimal outcome. The ideal type of treatment of patients with schizophrenia with subcapital hip fracture is still missing. It is, therefore, important to highlight the high risk of postoperative complications in patients with schizophrenia who present with subcapital fractures subsequently treated with hemiarthroplasty.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| | | | - Nikolaos Milonakis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC
| | - Evangelia M Tsapakis
- 1st Academic Department of Psychiatry, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Psychiatry, Agios Charalambos Mental Health Clinic, Heraklion, GRC
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
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88
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Liu Y, Chen X, Zhang P, Jiang B. Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomized control trials. J Orthop Surg Res 2020; 15:215. [PMID: 32527294 PMCID: PMC7291510 DOI: 10.1186/s13018-020-01725-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Displaced femoral neck fractures (DFNF) are increasingly common in elderly patients. Hip arthroplasty, the recommended treatment of DFNF, consists of the total hip arthroplasty (THA) and hemiarthroplasty (HA). THA is superior to HA in younger patients. However, there are concerns whether the more substantial surgical trauma and higher dislocation rate would trade off the advantages of THA due to frailty and lower physical demands in the elderly over 75 years. METHODS We conducted the literature search by searching PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and Web of Science from the inception dates to June 1, 2019. Randomized controlled trials (RCTs) were included according to the inclusion and exclusion criteria. Included studies were analyzed according to Cochrane review methods. RESULTS Nine studies met the inclusion criteria totaling 631 participants (301 THA and 330 HA). Four of the studies conducted were identical to a previous study but look at different follow-up periods. Our study revealed that THA was superior in terms of pain HHS, total HHS, EQ-5D, and acetabulum erosion, with a trend of a lower mortality rate within 6 months after surgery. However, the THA group had a longer average operative time and higher dislocation rate, with a trend towards a higher general complication rate. Moreover, there was no significant difference in terms of reoperation rate, postoperative infection, peri-prosthetic fracture, and VTE prevalence across the groups. CONCLUSIONS THA may be a preferred management option for active elderly patients over 75 years old, which can provide superior hip function and life quality with acceptable risks. Strict management should be followed to prevent dislocation following a THA, especially within the first 6 months. TRIAL REGISTRATION This study was registered at the International Prospective Register of Systematic Reviews (CRD42019139135).
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Affiliation(s)
- Yijun Liu
- Department of Orthopaedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiaokun Chen
- Department of Orthopaedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Peixun Zhang
- Department of Orthopaedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Baoguo Jiang
- Department of Orthopaedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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89
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Viswanath A, Malik A, Chan W, Klasan A, Walton NP. Treatment of displaced intracapsular fractures of the femoral neck with total hip arthroplasty or hemiarthroplasty. Bone Joint J 2020; 102-B:693-698. [PMID: 32475248 DOI: 10.1302/0301-620x.102b6.bjj-2019-1459.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Despite few good-quality studies on the subject, total hip arthroplasty (THA) is increasingly being performed for displaced intracapsular fractures of the neck of femur. We compared outcomes of all patients with displacement of these fractures treated surgically over a ten-year period in one institution. METHODS A total of 2,721 patients with intracapsular fractures of the femoral neck treated with either a cemented hemiarthroplasty or a THA at a single centre were retrospectively reviewed. The primary outcomes analyzed were readmission for any reason and revision surgery. We secondarily looked at mortality rates. RESULTS We found no difference in the overall revision rate or rate of infection. However, the rates of readmission due to dislocation, pain, and trochanteric bursitis were significantly higher in the THA group (p = 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). CONCLUSION Our study, comparing the outcomes of neck of femur fractures treated with a cemented hemiarthroplasty and THA, revealed the perceived superiority of THA was not borne out by our results. This should be carefully considered before any radical change in practice regarding the use of THA for displaced intracapsular fractures of the femoral neck. Cite this article: Bone Joint J 2020;102-B(6):693-698.
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Affiliation(s)
| | - Anum Malik
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Warwick Chan
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Neil P Walton
- Norfolk and Norwich University Hospital, Norwich, UK
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90
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Suarez JC, Arguelles W, Saxena A, Rivera P, Parris D, Veledar E. Hemiarthroplasty vs Total Hip Arthroplasty for Femoral Neck Fractures: 2010-2017 Trends in Complication Rates. J Arthroplasty 2020; 35:S262-S267. [PMID: 32222266 DOI: 10.1016/j.arth.2020.02.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Optimal treatment of femoral neck fractures (FNFs) remains debated. Recent data suggest that total hip arthroplasty (THA) confers improved functional outcomes compared to hemiarthroplasty (HA) in active patients. However, temporal trends in complication rates between these treatments lack study. METHODS The National Surgical Quality Improvement Program database was retrospectively queried to compare differences between HA and THA over time (2010-2012, 2013-2015, and 2016-2017) in blood transfusions, operation time, major complications, minor complications, and 30-day readmission, among FNF patients aged ≥50 years. Analyses adjusted for age, gender, anesthesia type, smoking, body mass index, hypertension, bleeding disorder, steroid use, and American Society of Anesthesiologists classification. RESULTS In total, 16,213 patients were identified. THA was associated with higher transfusion rates in 2010-2012 (mean = 0.34 vs 0.28, P = .001) and 2013-2015 (mean = 0.21 vs 0.19, P = .002), but not in 2016-2017 (mean = 0.13 vs 0.14, P = .146). Operation time was significantly higher for THA across all periods (P's < .001), but declined over time. In recent years, THA was associated with less major (2016-2017: 5.4% vs 10.2%, P = .02; 2013-2015: 5.3% vs 10.3%, P < .001) and minor (2016-2017: 6.2% vs 9.8%, P = .02; 2013-2015: 7.2% vs 12.4%, P < .001) complications compared to 2010-2012 (major: 7.2% vs 10.6%, P = .87; minor: 12.6% vs 10.1%, P = .89). No differences in 30-day readmission were noted. CONCLUSION THA was associated with less major and minor complications in recent time periods compared to HA for the treatment of FNF, controlling for comorbidities. THA trends in transfusions and operation duration have improved over time compared to HA.
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Affiliation(s)
- Juan C Suarez
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL
| | - William Arguelles
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Priscilla Rivera
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Don Parris
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Emir Veledar
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
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91
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Blythe R, O'Gorman PM, Crawford RW, Feenan R, Hatton A, Whitehouse SL, Graves N. Fixation Method for Hip Arthroplasty Stem Following Hip Fracture: A Population-Level Cost-Effectiveness Analysis. J Arthroplasty 2020; 35:1614-1621. [PMID: 32197963 DOI: 10.1016/j.arth.2020.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip arthroplasty is increasing in Australia. The number of procedures for fractured neck of femur was 7500 in 2017. Best practices for fixation method and procedure type require scrutiny. This paper is about the costs and health outcomes of cemented and uncemented hemiarthroplasty and total hip arthroplasty at a national level. METHODS We created a Markov model for patients <75, aged 75-85, and over 85. Expected costs and health outcomes over 5 years from a decision to change from existing practice to a best practice policy in which all patients with fractured neck of femur received the same fixation method based on age and type of arthroplasty are estimated. The model was populated using prevalence and incidence data from the Australian Orthopedic Association National Joint Replacement Registry, costs from Metro North Hospital and Health Service in Queensland, and probabilities and utilities from the literature. We simulated the uncertainties in outcomes with probabilistic sensitivity analysis. RESULTS We found that uncemented stem procedures were more costly and provided worse health outcomes compared to cemented stem fixation for hemiarthroplasty and total hip arthroplasty for all age groups. Moving from existing practice to cemented stem arthroplasty could save the Australian health system $2.0 million over 5 years with a gain of 203 quality-adjusted life years. CONCLUSION We suggest that consideration be given to cemented fixation of the femoral stem for patients receiving both hemiarthroplasty and total hip arthroplasty for fractured neck of femur. Best practice guidelines focused on cost-effectiveness should recommend cemented stem fixation to both save costs and improve patient quality of life.
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Affiliation(s)
- Robin Blythe
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patricia M O'Gorman
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Gold Coast University Hospital, Queensland Health, Brisbane, Queensland, Australia; Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ross W Crawford
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rachel Feenan
- Strategic Procurement, Health Support Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Alesha Hatton
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Sarah L Whitehouse
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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92
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Lutnick E, Kang J, Freccero DM. Surgical Treatment of Femoral Neck Fractures: A Brief Review. Geriatrics (Basel) 2020; 5:E22. [PMID: 32244621 PMCID: PMC7345750 DOI: 10.3390/geriatrics5020022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Abstract
Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.
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Affiliation(s)
- Ellen Lutnick
- Jacobs School of Medicine and Biomedical Sciences, 955 Main St., Buffalo, NY 14203, USA;
| | - Jeansol Kang
- Boston University School of Medicine, Department of Orthopaedics, 850 Harrison Ave. Dowling 2N, Boston, MA 02118, USA;
| | - David M. Freccero
- Boston University School of Medicine, Department of Orthopaedics, 850 Harrison Ave. Dowling 2N, Boston, MA 02118, USA;
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93
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Neyisci C, Erdem Y, Bilekli AB, Bek D. Direct Anterior Approach Versus Posterolateral Approach for Hemiarthroplasty in the Treatment of Displaced Femoral Neck Fractures in Geriatric Patients. Med Sci Monit 2020; 26:e919993. [PMID: 31961830 PMCID: PMC6993556 DOI: 10.12659/msm.919993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background In the present study, we aimed to evaluate early clinical and biochemical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for hemiarthroplasty in the treatment of displaced femoral neck fractures in geriatric patients. Material/Methods Between September 2012 and September 2017, a total of 110 patients who underwent hemiarthroplasty for displaced femoral neck fractures were retrospectively analyzed. The patients were divided into 2 groups according to the surgical technique PLA (Group 1, n=54) and DAA (Group 2, n=56). Clinical and biochemical results were compared. Results There was no significant difference in the demographic characteristics of the patients, fixation type, and follow-up (P>0.05). However, there was a significant difference in the duration of surgery, amount of blood transfusion, change from baseline in postoperative hemoglobin levels, amount of intraoperative gauze dressing, amount of drainage fluid from the surgical wound, postoperative VAS scores, incision length, length of hospital stay, and Barthel Index scores in favor of DAA group (P<0.05). There was no significant difference in the degree of mobilization (P>0.05). None of the patients had postoperative complications in Group 1, while 3 patients in Group 2 developed a lateral femoral cutaneous nerve lesion and one patient had a missed iatrogenic fracture of the greater trochanter. Conclusions Our study results suggest that early clinical and biochemical outcomes are better in DAA than PLA with early return to daily living activities in patients undergoing hemiarthroplasty for displaced femoral neck fractures.
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Affiliation(s)
- Cagri Neyisci
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Erdem
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ahmet Burak Bilekli
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Dogan Bek
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
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94
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Affiliation(s)
- Cecilia Rogmark
- Department of Orthopaedics, Skåne Univerisity Hospital, Malmö, Sweden,
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95
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Affiliation(s)
- Jan-Erik Gjertsen
- From the Department of Orthopedic Surgery, Haukeland University Hospital, and the Institute of Clinical Medicine, University of Bergen - both in Bergen, Norway
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96
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Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfán E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky S, Heels-Ansdell D, Thabane L, Walter SD, Devereaux PJ. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med 2019; 381:2199-2208. [PMID: 31557429 DOI: 10.1056/nejmoa1906190] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Globally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty. METHODS We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points. RESULTS The primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723 patients (8.3%) who were randomly assigned to hemiarthroplasty (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P = 0.79). Hip instability or dislocation occurred in 34 patients (4.7%) assigned to total hip arthroplasty and 17 patients (2.4%) assigned to hemiarthroplasty (hazard ratio, 2.00; 99% CI, 0.97 to 4.09). Function, as measured with the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty. Mortality was similar in the two treatment groups (14.3% among the patients assigned to total hip arthroplasty and 13.1% among those assigned to hemiarthroplasty, P = 0.48). Serious adverse events occurred in 300 patients (41.8%) assigned to total hip arthroplasty and in 265 patients (36.7%) assigned to hemiarthroplasty. CONCLUSIONS Among independently ambulating patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who were randomly assigned to undergo total hip arthroplasty and those who were assigned to undergo hemiarthroplasty, and total hip arthroplasty provided a clinically unimportant improvement over hemiarthroplasty in function and quality of life over 24 months. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov number, NCT00556842.).
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Affiliation(s)
- Mohit Bhandari
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Thomas A Einhorn
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Gordon Guyatt
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Emil H Schemitsch
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Robert D Zura
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Sheila Sprague
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Frede Frihagen
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Ernesto Guerra-Farfán
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Ydo V Kleinlugtenbelt
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Rudolf W Poolman
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Amar Rangan
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Sofia Bzovsky
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Diane Heels-Ansdell
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Lehana Thabane
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Stephen D Walter
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - P J Devereaux
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
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Tucker NJ, Kamath AF. Comparing total hip arthroplasty and hemiarthroplasty in the treatment of hip fracture. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S259. [PMID: 32015978 DOI: 10.21037/atm.2019.12.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nicholas J Tucker
- 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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98
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Lu Y, Uppal HS. Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation. Geriatr Orthop Surg Rehabil 2019; 10:2151459319859139. [PMID: 31321116 PMCID: PMC6610445 DOI: 10.1177/2151459319859139] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Hip fractures represent an important health-care dilemma, costing the US$ billions annually. Hip fractures can diminish quality of life and significantly increase morbidity and mortality if not properly treated. Recent research has brought forth new information regarding treatment as well as information on emerging complications seen within the fixation constructs themselves. Significance Understanding the pathoanatomy of hip fractures and the biomechanics of surgical fixation constructs is critical for successful treatment. In this article, we review the relevant anatomy and classification of femoral neck and intertrochanteric fractures. Furthermore, the biomechanics of hip fracture fixation strategies as well as implant-related complications are addressed. Results Even though laboratory testing demonstrated that intramedullary nails have greater biomechanical stability, the clinical results between fixation constructs have been similar when the chosen implant (ie, sliding hip screw vs cephalomedullary nail) has been correctly applied to the specific fracture pattern. Recently, data have shown that when using cephalomedullary nails, there is potential for increased failure with cutout when using the helical blade versus the lag screw, with majority being the atypical "medial cutout." Conclusion The goal of surgical treatment of hip fractures is surgical treatment that allows for early mobilization and weight bearing. A full understanding of the anatomy and fracture characteristics will allow the surgeon to correctly apply the right implant to allow for uneventful healing. Surgeons need to be aware, however, of complications that can arise when using specific implants. Further research is ongoing to further determine the treatments that will allow optimal cost-effective care for the geriatric patient with hip fracture.
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Affiliation(s)
- Young Lu
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
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