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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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Liu Y, Zhang CW, Zhao XD. Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord 2020; 21:217. [PMID: 32268893 PMCID: PMC7140318 DOI: 10.1186/s12891-020-03249-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period. Methods From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions. Results Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P75-P25) = 53 (59) versus median (P75-P25) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group. Conclusions Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.
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Affiliation(s)
- Yang Liu
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041.
| | - Chong-Wei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
| | - Xiao-Dan Zhao
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
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Chinzei N, Noda M, Matsushita T, Inui A, Osawa S, Okimura K, Takahashi M, Saegusa Y. Does the duration to bipolar hip arthroplasty for femoral neck fracture influence on postoperative muscular strength? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:251-256. [PMID: 31493025 DOI: 10.1007/s00590-019-02545-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The primary purpose of this study was to compare the postoperative muscular strength and functional performance between early versus late bipolar hip arthroplasty (BHA) intervention for femoral neck fracture classified by the duration from the onset to surgery. METHODS Twenty-one patients who could walk at 12 months or more after BHA were enrolled into this study. We examined the muscular strength of hip flexion, extension, abduction, and knee extension of these patients. Time of one-leg standing, timed up and go test, pain grade by visual analog scale, and Barthel index were also evaluated as functional indices. We classified these patients into two groups by the duration from the onset to surgery, namely: within 3 days until BHA (early OP) and more than 4 days (late OP) to compare these indices at the latest follow-up. RESULTS The mean days until operation were 2.3 days in the early-OP group and 5.9 days in the late-OP group, showing a significant difference between the two groups. Muscular strength and other functional indices were also found to have no significant differences between these two groups. CONCLUSION Our study suggests that the delay to operate might not severely compromise the muscular strength around the hip joint for least 1.5 years among ambulatory patients.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Mitsuaki Noda
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Shin Osawa
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Kenjiro Okimura
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Masayasu Takahashi
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Yasuhiro Saegusa
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
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The Outcomes of Treating Femoral Neck Fractures Using Bipolar Hemiarthroplasty. Trauma Mon 2016. [DOI: 10.5812/traumamon.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2015; 40:1843-8. [DOI: 10.1007/s00264-015-3033-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022]
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Jain D, Sidhu GS, Selhi HS, Mears SC, Yamin M, Mahindra P, Pannu HS. Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture. Geriatr Orthop Surg Rehabil 2015; 6:42-6. [PMID: 26246953 DOI: 10.1177/2151458514567314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for comanagement of these injuries by orthopedic and internal medicine teams at our hospital in India. From January 2010 till December 2011, 119 patients with a femoral neck fracture were treated with cemented modular hemiarthroplasty under this program using a cost-effective Indian implant. The cohort included 63 males and 56 females with a mean age of 70.7 years (range 55-98 years). Hypertension (n = 42) and diabetes mellitus (n = 29) were the most common comorbidities. The follow-up period ranged from 12 to 37 months with an average of 24 months. The surgery was performed within 24 hours of admission in 60.5% (n = 72) patients. The use of antiplatelet drugs was the most common reason for delay of surgery. The mean length of hospital stay was 10.4 days (range 3-24 days) with 77% (n = 92) of patients discharged within 1 week of admission. On follow-up, good to excellent Harris hip scores were seen in 88% of patients with 76% of patients returning to the preinjury ambulatory status. The mortality rate was 6% at 6 months follow-up and 10.9% at 2 years. Our study shows that a hip fracture program can be instituted in India. The program helped us in achieving the goal of early surgery, mobilization, and discharge from hospital with decreased mortality.
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Affiliation(s)
- Deepak Jain
- Department of Orthopedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Guraziz Singh Sidhu
- Department of Orthopedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpal Singh Selhi
- Department of Orthopedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Simon C Mears
- Orthopaedic Surgeon, Baylor Regional Medical Center, Plano, TX, USA
| | - Mohammad Yamin
- Department of Orthopedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Pankaj Mahindra
- Department of Orthopedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harminder Singh Pannu
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Biber R, Brem M, Bail HJ. Targon Femoral Neck for femoral-neck fracture fixation: lessons learnt from a series of one hundred and thirty five consecutive cases. INTERNATIONAL ORTHOPAEDICS 2013; 38:595-9. [PMID: 24271332 DOI: 10.1007/s00264-013-2176-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/30/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Internal fixation versus joint replacement for treating intracapsular hip fractures is still a major debate. The Targon FN fixation concept is innovative; two small case series are promising. We present the first larger series. METHODS We conducted prospective documentation of all Targon FN cases since 2006. The implant was used for all undisplaced fractures, and for displaced fractures in patients of a biological age ≤60 years. Besides demographic data and fracture classification, we analysed infection, haematoma, implant perforation, nonunion and operative revision procedures. RESULTS In 135 cases (mean age 71 years; average operation time 60 minutes; average hospital stay ten days), we found a surgical complication rate of 16.4%. Conversion to joint replacement was necessary in 9.6%. Complication rate was significantly higher in displaced fractures. CONCLUSIONS Our study confirms low general complication rates. However, implant perforation seems to be underestimated. Optimised reduction technique may help to reduce this complication.
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Affiliation(s)
- Roland Biber
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg, Breslauer Strasse 201, Nürnberg, 90471, Germany,
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A comparative biomechanical study of proximal femoral nail (InterTAN) and proximal femoral nail antirotation for intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2013; 37:2465-73. [PMID: 24091417 DOI: 10.1007/s00264-013-2120-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the biomechanical strength of the cephalomedullary nail InterTAN in cases of intertrochanteric fractures with the commonly used PFNA. METHODS Sixteen fresh specimens of the proximal femur were used as intertrochanteric fracture models and were fixed using two fixation devices: the new proximal femoral nail (InterTAN) and proximal femoral nail antirotation (PFNA). An intertrochanteric fracture was created in composite bone models. Each specimen was loaded to simulate single leg stance while stiffness, migration (cut out), compressive force across the fracture site, and distal fragment rotation were monitored. The different internal fixation methods were tested by an experimental press analysis. RESULTS Results of tests for femoral strength, stiffness, stability, and bearing capacity demonstrated that the biomechanical function of InterTAN was better than that of PFNA (P < 0.05). Compared with the PFNA nail, InterTAN showed increased strength, stiffness, and resistance torque of 30%, 15%, and 27%, respectively. CONCLUSION Comparison of the treatment of intertrochanteric fractures with InterTAN and PFNA internal fixation showed that the InterTAN yielded improvement relative to the PFNA. InterTAN has a firmer and biomechanically superior performance and is therefore an ideal internal fixation method for treating intertrochanteric fractures. Additional research in osteopenic bone is necessary to comprehensively characterize the effects of the design enhancements of these two implants.
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