1
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Tekin C, Gunaydin B, Karıksız M. HOOK ASSISTED REDUCTION IN CEPHALOMEDULLARY NAILING WITHOUT TRACTION TABLE. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e274533. [PMID: 38933356 PMCID: PMC11197950 DOI: 10.1590/1413-785220243202e274533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/15/2024] [Indexed: 06/28/2024]
Abstract
Introduction Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern. We aimed to overcome this difficulty with the hook. Materials and Methods A retrospective study of 60 patients. 28 of the patients reduction was necessitated with a hook (group 1). The other patients did not need to use this technique (group 2, n=32). The collo-diaphyseal angle, lag screw placement, and tip-apex distance were measured using radiographs. Results There were statistically significant differences between the two groups regarding the Garden Alignment Index, postoperative collo-diaphyseal angle measurements, and tip-apex distance. The Garden Alignment Index was found as 163.92 degrees (dg.) In the frontal plane in group 1, and 154.78 dg in group 2, respectively. In group 1, the tip-apex distance was 16.05 cm, whereas it was 25.32 cm in group 2. The collo-diaphyseal angle was 133.1º in group 1, and 128.65º in group 2. Conclusions The hook-assisted reduction is beneficial when operating without a traction table; however, it can also be a part of the surgeons' equipment even when operating on a traction table. When difficulties in obtaining an ideal anatomical reduction in displaced intertrochanteric femoral fractures, we suggest using the hook-assisted reduction technique. Level of Evidence III; Case-control Study.
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Affiliation(s)
- Cagatay Tekin
- Istanbul Cam and Sakura City Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Burak Gunaydin
- Tekirdag Namik Kemal University Medical Faculty, Orthopaedics and Traumatology Department, Turkey
| | - Mesut Karıksız
- Başakşehir Cam and Sakura City Hospital, Orthopedic and Traumatology, Istanbul, Turkey
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2
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Shah ID, Piple AS, Schlauch AM, Crawford BD, Tamer P, Prentice HA, Grimsrud CD. Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures. J Orthop Trauma 2023; 37:539-546. [PMID: 37348042 DOI: 10.1097/bot.0000000000002650] [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] [Accepted: 06/08/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and the posterior approach for total hip arthroplasty in geriatric patients with displaced femoral neck fractures (FNFs). DESIGN Retrospective cohort study. SETTING Multicenter Health care Consortium. PATIENTS Seven-hundred and nine patients 60 years or older with acute displaced FNFs between 2009 and 2021. INTERVENTION Total hip arthroplasty using either DAA or posterior approach. MAIN OUTCOME MEASUREMENTS Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents). RESULTS Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ( B = -6.89 minutes; 95% confidence interval [CI] -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (adjusted odds ratios = 0.54; 95% CI 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 morphine milligram equivalents; 95% CI -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. CONCLUSION When comparing the DAA versus posterior approach for total hip arthroplasty performed for displaced FNF, DAA was associated with shorter operative time, lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ishan D Shah
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Amit S Piple
- The Taylor Collaboration, St. Mary's Medical Center, San Francisco, CA
| | - Adam M Schlauch
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Benjamin D Crawford
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Pierre Tamer
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Heather A Prentice
- Medical Device and Surveillance Department, Kaiser Permanente, San Diego, CA; and
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Nho JH, Seo GW, Kang TW, Jang BW, Park JS, Suh YS. Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique. Hip Pelvis 2023; 35:99-107. [PMID: 37323545 PMCID: PMC10264230 DOI: 10.5371/hp.2023.35.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. Materials and Methods A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Results Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Conclusion Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.
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Affiliation(s)
- Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Tae Wook Kang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jong-Seok Park
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - You-Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
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Bundled Payments for Hip Fracture Surgery Are Associated With Improved Access, Quality, and Health Care Utilization, but Higher Costs for Complex Cases: An Interrupted Time Series Analysis. J Orthop Trauma 2023; 37:19-26. [PMID: 35839456 DOI: 10.1097/bot.0000000000002459] [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] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To study the impact of bundled payments for surgically managed hip fractures on care access, care quality, health care resource utilization, clinical impact, and acute care cost. DESIGN An observational retrospective cohort study using a quasi-experimental design comparing prebundled and postbundled payments through an interrupted time series analysis. SETTING A public acute care general hospital. PATIENTS Patients 60 years and older, with surgery for an isolated, unilateral, nonpathological hip fracture during 2014-first quarter of 2019 [diagnosis-related group codes: I03A, I03B, I08A, and I08B] and transferred to specific rehabilitation institutions were studied. INTERVENTION Bundled payments for funder-to-provider reimbursement. MAIN OUTCOMES MEASUREMENTS Care access, care quality, health care resource utilization, clinical impact, and cost. RESULTS Of 1477 patients, 811 were assigned to prebundled and 666 to postbundled payments. Although there was an improving trend of ward admission waiting times during postbundled payments [odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.02-1.28], ward admission waiting times were longer when compared with prebundled payments (OR = 0.45; 95% CI: 0.23-0.85). Rates of 30-day all-cause readmissions were lower (OR = 0.08; 95% CI: 0.01-0.67), and trends of reducing inpatient rehabilitation and overall episode length of stay (OR = 1.26; 95% CI: 1.16-1.37 and OR = 1.17; 95% CI: 1.07-1.28, respectively) were demonstrated during postbundled payments. Acute care cost for complex cases were higher (OR = 0.49; 95% CI: 0.26-0.92) during bundled payments, compared with prebundled payments. CONCLUSIONS Bundled payments for surgically managed hip fractures were associated with benefits for several outcomes pertinent to clinical improvement initiatives. More work, especially concerning cost-effective surgical implants and better care cost computations, are critically needed to contain the growth of acute medical care cost for these patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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5
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Pflüger P, Schlickewei C, Barg A, Valderrabano V. [Postprimary early elective total arthroplasty in severe ankle fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:946-950. [PMID: 36416890 PMCID: PMC9705496 DOI: 10.1007/s00113-022-01252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Treatment of the ankle joint with total ankle arthroplasty (TAA) is an established and safe surgical treatment for osteoarthritis of the ankle. Modern implants have low revision rates and are superior to ankle arthrodesis in terms of patient-reported outcomes. The importance of primary TAA treatment of ankle fractures is unclear. There are currently no studies in the literature on this topic. In view of the increasing number of cases of unstable ankle fractures, especially in older patients and with increasing functional demands also in old age, it is important to consider TAA in the management of these fractures in the future. Clinical studies are necessary to evaluate the treatment of ankle fractures using TAA.
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Affiliation(s)
| | - Carsten Schlickewei
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Alexej Barg
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Professor University of Basel, Swiss Medical Network, Schmerzklinik Basel, Hirschgässlein 15, 4010, Basel, Schweiz.
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6
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Jin Z, Xu S, Yang Y, Wei Y, Tian Y, Wang Z, Bai L. Cemented hemiarthroplasty versus proximal femoral nail antirotation in the management of intertrochanteric femoral fractures in the elderly: a case control study. BMC Musculoskelet Disord 2021; 22:846. [PMID: 34610813 PMCID: PMC8493738 DOI: 10.1186/s12891-021-04586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background The treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. Hence, this study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly. Methods Overall, 99 patients (81.09 ± 8.29 years; 68 women) underwent HA or PFNA from January 2016 to May 2020. IFF were classified according to the Arbeitsgemeins für Osteosynthesefragen (AO) classification. The difference in underlying diseases, the American Society of Anesthesiologists (ASA) grade, Singh index, Harris scores, surgical time, intraoperative bleeding, postoperative blood test results, postoperative number of days to partially bearing weight, and survival outcomes were analyzed. Postoperative follow-ups were performed every 3 months. Results There was no significant difference in the AO classification, underlying diseases, ASA grade, Singh index, surgical time, and survival outcomes of the HA (45 patients) group and PFNA group (54 patients). The HA group was associated with earlier partial weight-bearing (HA: 4 [2 ~ 4.5] days, PFNA: 10 [8~14] days). It also had a higher total Harris score than the PFNA group at the 6-month follow-up visit (HA: 86.8 [81.90 ~ 90.23], PFNA: 83.48 [75.13 ~ 88.23]). Harris scores decreased more in patients aged ≥90 years in the PFNA group than in the HA group. The postoperative stress recovery rate in the HA group was faster based on postoperative blood test results. Conclusions PFNA and HA have good therapeutic effects in the treatment of IFF. The advantages of HA were reflected in short-term weight bearing, faster recovery from stress, and better joint function in the long term. This advantage is more obvious in the patient population aged over 90 years. Therefore, we suggest that surgeons should consider the benefit of HA in the treatment of IFF among the elderly. Trial registration Chinese Clinical Trial Registry, ChiCTR2000035814. Registered 17 August 2020, https://www.chictr.org.cn/showproj.aspx?proj=57083
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Affiliation(s)
- Zhuangzhuang Jin
- China Medical University, Shenyang, Liaoning, China.,Department of Emergence Medicine, Shengjing Hospital Affiliated China Medical University, Shenyang, Liaoning, China
| | - Shuoyan Xu
- China Medical University, Shenyang, Liaoning, China.,Department of Nuclear medicine, The First Hospital Affiliated China Medical University, Shenyang, Liaoning, China
| | - Yue Yang
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Yingliang Wei
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Yicheng Tian
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Ziyuan Wang
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Lunhao Bai
- China Medical University, Shenyang, Liaoning, China. .,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China.
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Al-Mohrej OA, Alshaalan FN, Aldakhil SS, Rahman WA. One-Year Mortality Rates Following Fracture of the Femoral Neck Treated With Hip Arthroplasty in an Aging Saudi Population: A Trauma Center Experience. Geriatr Orthop Surg Rehabil 2020; 11:2151459320922473. [PMID: 32426174 PMCID: PMC7218334 DOI: 10.1177/2151459320922473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/28/2020] [Accepted: 04/02/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Femoral neck fracture is a common problem in elderly patients, and it is managed with either total hip arthroplasty or hemiarthroplasty with very good outcomes. However, the reported 1-year mortality rate is as high as 33%. Material and Methods: This study was a retrospective cohort study. The electronic patient records were searched for all physiologically old patients with displaced femoral neck fractures that were managed with either hemiarthroplasty or total hip arthroplasty. The primary aim of this study was to estimate morbidity and mortality rates at 30 days and 1 year. The secondary outcome was to determine major complications and factors influencing mortality. Results: From January 2017 to December 2018, a total of 99 patients were included in the study. Of those, 57 were female patients. The mortality rate was 15.2%. The significant predictors of death included the age at the time of surgery, readmission within 30 days of initial admission, acute renal impairment, and the need for preoperative medical intervention. Patients treated with total hip arthroplasty had lower mortality rates than those treated with hemiarthroplasty (P = .017). Discussion: To the best of our knowledge, this is the first study conducted in Saudi Arabia to report detailed perioperative-related complications and outcomes following neck of femur fractures. The results of our study confirm the persistently high morbidity and mortality associated with this patient group. Conclusion: Efforts should be aimed at optimizing preoperative medical management, which is vital to ensure early identification of medically unfit patients.
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Affiliation(s)
- Omar A Al-Mohrej
- Both authors contributed equally to this work.,Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fawaz N Alshaalan
- Both authors contributed equally to this work.,Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sahar S Aldakhil
- Division of Orthopedic Surgery, Department of Surgery, King Abdulaziz Medical City-National Guard, Riyadh, Saudi Arabia
| | - Wael A Rahman
- Department of Orthopedic Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia.,Department of Orthopedic Surgery, Mansoura University, Mansoura, Egypt
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Sivasundaram L, Tanenbaum JE, Mengers SR, Trivedi NN, Su CA, Salata MJ, Ochenjele G, Voos JE, Wetzel RJ. Identifying a clinical decision tool to predict discharge disposition following operative treatment of hip fractures in the United States. Injury 2020; 51:1015-1020. [PMID: 32122627 DOI: 10.1016/j.injury.2020.02.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Post-discharge management following operative treatment of hip fractures continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. Predicting discharge to post-acute care (PAC) facilities (i.e. skilled nursing facilities and inpatient rehabilitation facilities) can assist preoperative planning and potentially decrease length of stay secondary to disposition issues. The goal of this study was to develop a nomogram using easily identified variables to preoperatively predict discharge disposition following operative treatment of hip fractures. METHODS Using the National Surgical Quality Improvement Program database, patients who underwent surgical intervention for hip fractures between 2012 and 2015 were identified. A multivariable logistic regression model was used to identify risk factors for discharge to a PAC facility, and a predictive nomogram was created based on these results. RESULTS From 2012 to 2015, 33,371 hip fractures were identified: 13,336 (40%) femoral neck fractures, and 20,035 (60%) intertrochanteric femur fractures. Of the patients identified, 26,082 (78.2%) were discharged to a PAC while the remainder were discharged home with or without home health. 70% of patients were female and 92.4% were Caucasian. When accounting for comorbidities, using the American Society of Anesthesiologists (ASA) classification system, 6,122 patients (18.4%) had 'Mild Systemic Disease' (ASA 2), 20,872 (62.6%) patients had 'Severe Systemic Disease' (ASA 3), and 6,006 (18.1%) had 'Life Threatening Disease' (ASA 4/5). The majority of patients were brought in from a 'Home' setting, while 10.4% of patients were admitted from a 'Long-Term Care' setting. After controlling for confounding variables, older age and increasing ASA class were predictive of an increased risk of discharge to a PAC. Diabetes, dyspnea, congestive heart failure, and chronic obstructive pulmonary disease were not associated with an increased risk of discharge to a PAC. DISCUSSION Discharge disposition following operative treatment of hip fractures can be reliably predicted using a nomogram with commonly identified preoperative variables. LEVEL OF EVIDENCE Level III, Retrospective Cohort Design, Observational Study.
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Affiliation(s)
- Lakshmanan Sivasundaram
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States; MetroHealth Medical Center, Cleveland, OH, United States
| | - Joseph E Tanenbaum
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Sunita Rp Mengers
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States.
| | - Nikunj N Trivedi
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Charles A Su
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Michael J Salata
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - George Ochenjele
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - James E Voos
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Robert J Wetzel
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
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9
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Do current comorbidity indices accurately predict adverse events after operative fixation of hip fractures? A retrospective database review. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Boniello AJ, Lieber AM, Denehy K, Cavanaugh P, Kerbel YE, Star A. National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database. World J Orthop 2020; 11:18-26. [PMID: 31966966 PMCID: PMC6960302 DOI: 10.5312/wjo.v11.i1.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/25/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.
AIM To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups.
METHODS We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.
RESULTS Of the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA.
CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS.
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Affiliation(s)
- Anthony J Boniello
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Alexander M Lieber
- Drexel University College of Medicine, Philadelphia, PA 19123, United States
| | - Kevin Denehy
- Bluegrass Orthopaedics, Lexington, KY 40509, United States
| | - Priscilla Cavanaugh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Yehuda E Kerbel
- Deparment of Orthopaedics, Hospital of University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Andrew Star
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
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11
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Stronach BM, Bergin PF, Perez JL, Watson S, Jones LC, McGwin G, Ponce BA. The rising use of total hip arthroplasty for femoral neck fractures in the United States. Hip Int 2020; 30:107-113. [PMID: 30834796 DOI: 10.1177/1120700019832989] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We examined the trends in the treatment of femoral neck fractures with arthroplasty in the United States from 2004-2013. METHODS We used the National Inpatient Sample database in conjunction with codes from the International Classification of Diseases, Ninth Revision, to identify patients receiving hemiarthroplasty (HA) or total hip arthroplasty (THA) for the treatment of closed femoral neck fracture from 2004-2013. We evaluated the trend of these 2 treatments along with demographics, comorbidities, length of stay and same admission mortality. RESULTS Our study identified 1,059,414 patients who underwent arthroplasty for the treatment of femoral neck fracture. We found a 42% increase in the use of THA during the study period from 8.4% in 2004 to 12.9% in 2013. While the large majority of patients received HA (87.1%), there was an overall decline in the use of HA (89,132 in 2004 to 85,635 in 2013) and increase in the use of THA (8,177 in 2004 to 11,375 in 2013). Patients receiving THA were younger (mean age 74.7 THA vs. 80.4 HA, p < 0.001) with fewer comorbidities, higher likelihood of discharge to home (24% THA vs. 10% HA, p < 0.001) and lower inpatient mortality rates (1.5 % THA vs. 2.4 % HA, p < 0.001) in comparison to HA. CONCLUSION There has been a significant increase in the use of THA over the last decade. Patients receiving THA were younger and healthier with fewer comorbidities, less likely to sustain a same admission mortality and more likely to discharge to home in comparison to HA patients.
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Affiliation(s)
- Benjamin M Stronach
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA
| | - Patrick F Bergin
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jorge L Perez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
| | - Shawna Watson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
| | - LaRita C Jones
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, AL, USA
| | - Brent A Ponce
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
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12
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Zhou S, Liu J, Zhen P, Shen W, Chang Y, Zhang H, Zhu Q, Li X. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study. BMC Musculoskelet Disord 2019; 20:500. [PMID: 31664982 PMCID: PMC6820901 DOI: 10.1186/s12891-019-2793-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. METHODS From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3-99.1 years [(83.7 ± 5.6) years]. The patients' bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. RESULTS All patients were followed for 12.5-36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). CONCLUSION Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. TRIAL REGISTRATION Registration Number: ChiCTR1900022846 . Reg Date:2019-04-26 00:27:33 Retrospective registration.
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Affiliation(s)
- Shenghu Zhou
- Department of Joint Surgery, Institute of Orthopedics, Xijing Hospital of Fourth Military Medical University, Xi'an, 710032, China.,Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Jun Liu
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Ping Zhen
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Weiwei Shen
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Yanfeng Chang
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Haoqiang Zhang
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China
| | - Qingsheng Zhu
- Department of Joint Surgery, Institute of Orthopedics, Xijing Hospital of Fourth Military Medical University, Xi'an, 710032, China.
| | - Xusheng Li
- Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China.
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Yu X, Zhang H, Zhang X, Xu R, She Y, Yu Z, Chen G. Effects of the ratios of marrow cavity diameter to intramedullary nail diameter from different layers on blood loss during perioperative period for femoral intertrochanteric fractures. Medicine (Baltimore) 2019; 98:e16936. [PMID: 31517814 PMCID: PMC6750344 DOI: 10.1097/md.0000000000016936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The study aimed to investigate the effect of ratios of marrow cavity diameter to intramedullary nail diameter from different layers on hidden blood loss (HBL), overt blood loss (OBL) and total blood loss (TBL) during using proximal femoral nail antirotation-Asian version (PFNA)-II for femoral intertrochanteric fractures.We retrospectively studied 70 patients treated in our hospital recently. We recorded postoperative hematocrit (Hct) and OBL during operation. TBL and HBL were calculated using CROSS equation. The ratios of marrow cavity diameter to intramedullary nail diameter from different layers, including start of funnel, end of funnel and femoral isthmus, were measured. The mean of the ratio from frontal and lateral X-ray were designated as R. We classified all included participants into a high and a low matching group according to z-score of R within each layer. TBL, HBL, and OBL were compared between the 2 groups. We applied multiple linear regression analysis between the HBL as a dependent variable and gender, age, body mass index, fracture type, and R as independent variables.The present study indicated a significant reduction in the HBL and TBL in the high matching group compared to low matching group on three layers, whereas it showed no significant difference in OBL between the 2 groups on three layers. It showed that R values from start of funnel and end of funnel were significantly associated with HBL.Matching rate of PFNA II at the funnel might be an important factor for HBL and TBL postoperatively.
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Flury A, Finsterwald M, Dimitriou D, Helmy N, Hasler J, Antoniadis A. Should advanced age be a contraindication to total hip arthroplasty in femoral neck fracture patients? A matched-control, retrospective study. J Orthop 2019; 17:25-29. [PMID: 31879469 DOI: 10.1016/j.jor.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction Due to demographic changes, the annual incidence of femoral neck fractures (FNF) in patients reaching the 9th and 10th decade of life is increasing. Although active and cognitively intact elderly patients could benefit from total hip arthroplasty (THA) in case of a FNF, there is no clear consensus on whether THA should be performed in this particular subgroup of patients with very advanced age. The purpose of this study was to report the complication rate, mortality, clinical outcomes and quality-adjusted life year (QALY) gained in patients treated with total THA for FNF, while having exceeded the mean life expectancy at the time of surgery, compared to a younger control group. Materials and Methods Patients treated with THA through a direct anterior approach (DAA) for FNF and exceeding the average life expectancy in Switzerland (age ≥ 83 y, n = 45) were matched for gender, body mass index (BMI) and ASA score with patients under the age of 83 (age = 65-83, n = 45). Perioperative complications, clinical and radiologic outcomes, as well as mortality were compared between groups. Results Total complication rate did not differ significantly with 22.2% in the older group compared to 17.8% in the control group. The 30-day and 1-year mortality was slightly but not significantly higher in the older group (2.2% and 8.9% vs. 2.2% and 2.2%). The average QALY gained was 3.4 years and 4.1 years for the older group and their younger counterparts, respectively. Conclusion THA through the DAA for FNF in cognitively intact and active patients might be a credible and safe option even after reaching mean life expectancy with excellent functional outcomes and similar surgery-related complications compared to patients younger than 83 years. Our results imply that an advanced age should not be considered a contraindication for THA in case of a FNF.
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Affiliation(s)
- Andreas Flury
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Julian Hasler
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Alexander Antoniadis
- Department of Orthopaedics and Traumatology, Buergerspital Solothurn, Solothurn, Switzerland
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Camurcu Y, Cobden A, Sofu H, Saklavci N, Kis M. What Are the Determinants of Mortality After Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients? J Arthroplasty 2017; 32:3038-3043. [PMID: 28550964 DOI: 10.1016/j.arth.2017.04.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/27/2017] [Accepted: 04/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Primary hemiarthroplasty is proposed for the treatment of unstable intertrochanteric fractures in elderly patients with the advantages of early mobilization, acceptable functional results, and lower failure rates. The 1-year mortality rates demonstrated high variance in the literature, whereas, the factors related to 1-year mortality were not widely investigated. The main purpose of the present study was to determine predictive factors related to 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture. METHODS One hundred six patients with the mean age of 80.7 years were included in this retrospective study. Age, gender, body mass index, comorbid diseases, American Society of Anesthesiologists score, total hospitalization time, time from injury to surgery, operation time, estimated blood loss, postoperative mobilization time, and decrease in Koval ambulatory categories were evaluated. Univariate and multivariate analyses were performed to determine major predictors of 1-year mortality. The Kaplan-Meier survival analysis was used to construct the cumulative survival rate. RESULTS Three or more American Society of Anesthesiologists scores, presence of ≥3 comorbid diseases, and postoperative mobilization time of ≥2 days were significantly correlated with 1-year mortality. Presence of ≥3 comorbid systemic diseases was identified as the major predictive factor for 1-year mortality. The overall 5-year cumulative survival rate was 5.6%. CONCLUSION Having three or more comorbid systemic diseases has been detected as the major determinant of 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture in elderly patients.
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Affiliation(s)
- Yalkin Camurcu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Adem Cobden
- Department of Orthopaedics and Traumatology, Sivas Numune Hospital, Sivas, Turkey
| | - Hakan Sofu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Nuh Saklavci
- Department of Orthopaedics and Traumatology, Sivas Numune Hospital, Sivas, Turkey
| | - Mehmet Kis
- Department of Orthopaedics and Traumatology, Sivas Numune Hospital, Sivas, Turkey
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Mingli F, Huiliang S, Guanglei C, Zheng L, Shibao L, Limin L, Shuai A. A clinical study on arthroplasty for failed internal fixation of hip fractures and review of literature. Pak J Med Sci 2017; 33:798-803. [PMID: 29067042 PMCID: PMC5648941 DOI: 10.12669/pjms.334.12459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background & Objective: Hip fracture is common osteoporotic fracture associated sometimes with failed internal fixation. Joint replacement is commonly used to salvage failed internal fixation of hip fractures (FIFHF). Our objective was to present the outcome of Arthroplasty after FIFHF in our patients. Methods: A prospective analysis was made on consecutive patients who underwent prosthetic replacements for FIFHF in Orthopaedics Department of Xuanwu Hospital between June 2012 and January 2015. Fifty six patients were included. There were 32 cases of failed internal fixation of femoral neck fracture (FIFFNF) and 24 cases of failed internal fixation of intertrochanteric fracture (FIFIF). The reoperations included 36 cases of total hip replacements, and 20 cases of bipolar femoral head replacements. Cemented prostheses were used in 19 patients (long-stems in 7 patients), and uncemented prostheses in 37 patients (long-stems in 12 patients). The patients were followed up for a minimum of 12 months or until their death. Results: Two patients died of pulmonary infection in the perioperative period, two died of myocardial infarction in two months after the operation, and the rest survived 12 month follow-up at the least. The mean Harris hip scores of the patients were 47 and 85 before and after the operation, respectively. The rate of Excellent and Good results is 82.7%. T tests showed that difference between pre and post-operation Harris hip scores is statistically significant (p <0.001). Conclusions: Arthroplasty may serve as a suitable salvage technique for FIFHF, and long-stem prosthesis replacement is proved to obtain reliable curative effect, especially in FIFIF.
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Affiliation(s)
- Feng Mingli
- Feng Mingli, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
| | - Shen Huiliang
- Shen Huiliang, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
| | - Cao Guanglei
- Cao Guanglei, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
| | - Li Zheng
- Li Zheng, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
| | - Lu Shibao
- Lu Shibao, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
| | - Liu Limin
- Liu Limin, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
| | - An Shuai
- An Shuai, MD. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Changchun Ave 45, Xicheng District, Beijing, 100053, China
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17
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Abstract
OBJECTIVES To determine if hospital arthroplasty volume affects patient outcomes after undergoing total hip arthroplasty (THA) for displaced femoral neck fractures. METHODS The Statewide Planning and Research Cooperative System database from the New York State Department of Health was used to group hospitals into quartiles based on overall THA volume from 2000 to 2010. The database was then queried to identify all patients undergoing THA specifically for femoral neck fracture during this time period. The data were analyzed to investigate outcomes between the 4 volume quartiles in 30-day and 1-year mortality, 1-year revision rate, and 90-day complication rate (readmission for dislocation, deep vein thrombosis, pulmonary embolism, prosthetic joint infection, or other complications related to arthroplasty in the treatment of femoral neck fractures with THA). RESULTS Patients undergoing THA for femoral neck fracture at hospitals in the top volume quartile had significantly lower 30-day (0.9%) and 1-year (7.51%) mortality than all other volume quartiles. There were no significant differences on pairwise comparisons between the second, third, and fourth quartiles with regard to postoperative mortality. There was no significant difference in revision arthroplasty at 1 year between any of the volume quartiles. On Cox regression analysis, THA for fracture at the lowest volume (fourth) quartile [hazard ratio (HR), 1.91; P = 0.016, 95% confidence interval (CI), (1.13-3.25)], second lowest volume (third) quartile (HR, 2.01; P = 0.013, 95% CI, 1.16-3.5) and third lowest volume (second) quartile (HR, 2.13; P = 0.005, 95% CI, 1.26-3.62) were associated with increased risk for a 1-year postoperative mortality event. Hospital volume quartile was also a significant risk factor for increased 90-day complication (pulmonary embolism/deep vein thrombosis, acute dislocation, prosthetic joint infection) following THA for femoral neck fracture. Having surgery in the fourth quartile (HR, 2.71; P < 0.001, 95% CI, 1.7-4.31), third quartile (HR, 2.61; P < 0.001, 95% CI, 1.61-4.23), and second quartile (HR, 2.41; P < 0.001, 95% CI, 1.51-3.84), all were significant risk factors for increased 90-day complication risk. CONCLUSIONS The results of this population-based study indicate that THA for femoral neck fractures at high-volume arthroplasty centers is associated with lower mortality and 90-day complication rates but does not influence 1-year revision rate. THA for femoral neck fractures at top arthroplasty volume quartile hospitals are performed on healthier patients more quickly. Patient health is a critical factor that influences mortality outcomes following THA for femoral neck fractures. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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18
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Maceroli MA, Nikkel LE, Mahmood B, Elfar JC. Operative Mortality After Arthroplasty for Femoral Neck Fracture and Hospital Volume. Geriatr Orthop Surg Rehabil 2015; 6:239-45. [PMID: 26623156 PMCID: PMC4647190 DOI: 10.1177/2151458515600496] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: The purpose of the present study is to use a statewide, population-based data set to identify mortality rates at 30-day and 1-year postoperatively following total hip arthroplasty (THA) and hemiarthroplasty (HA) for displaced femoral neck fractures. The secondary aim of the study is to determine whether arthroplasty volume confers a protective effect on the mortality rate following femoral neck fracture treatment. Methods: New York’s Statewide Planning and Research Cooperative System was used to identify 45 749 patients older than 60 years of age with a discharge diagnosis of femoral neck fracture undergoing THA or HA from 2000 through 2010. Comorbidities were identified using the Charlson comorbidity index. Mortality risk was modeled using Cox proportional hazards models while controlling for demographic and comorbid characteristics. High-volume THA centers were defined as those in the top quartile of arthroplasty volume, while low-volume centers were defined as the bottom quartile. Results: Patients undergoing THA for femoral neck fracture rather than HA were younger (79 vs 83 years, P < .001), more likely to have rheumatoid disease, and less likely to have heart disease, dementia, cancer, or diabetes (all P < .05). Thirty-day mortality after HA was higher (8.4% vs 5.7%; P < .001) as was 1-year mortality (25.9% vs 17.8%; P < .001). After controlling for age, gender, ethnicity, and comorbidities, risk of mortality following THA was 21% lower (hazard ratio [HR] 0.79; P = .003) at 30 days and 22% lower (HR 0.78; P < .001) at 1 year than HA. Patients undergoing THA at high-volume arthroplasty centers had improved 1-year mortality when compared to those undergoing THA at low-volume hospitals (HR 0.55; P = .008). Conclusions: Based on this large, population-based study, there is no basis to assume THA carries a greater mortality risk after hip fracture than does standard HA, even when accounting for institutional volume of hip arthroplasty.
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Affiliation(s)
- Michael A Maceroli
- Department of Orthopaedics, Center for Orthopaedic Population Studies, University of Rochester, Rochester, NY, USA
| | - Lucas E Nikkel
- Department of Orthopaedics, Center for Orthopaedic Population Studies, University of Rochester, Rochester, NY, USA
| | - Bilal Mahmood
- Department of Orthopaedics, Center for Orthopaedic Population Studies, University of Rochester, Rochester, NY, USA
| | - John C Elfar
- Department of Orthopaedics, Center for Orthopaedic Population Studies, University of Rochester, Rochester, NY, USA
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Boese CK, Buecking B, Bliemel C, Ruchholtz S, Frink M, Lechler P. The effect of osteoarthritis on functional outcome following hemiarthroplasty for femoral neck fracture: a prospective observational study. BMC Musculoskelet Disord 2015; 16:304. [PMID: 26475144 PMCID: PMC4609155 DOI: 10.1186/s12891-015-0767-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influence of pre-existing radiographic osteoarthritis on the functional outcome of elderly patientents with displaced intracapsular fractures of the femoral neck treated by hemiarthroplasty is unclear. METHODS We prospectively examined the impact of pre-existing osteoarthritis on the functional outcome of 126 elderly patients with displaced intracapsular fracture of the femoral neck treated by hemiarthroplasty. RESULTS The mean age of the cohort was 82.7 years. At 12 months, we observed no statistically significant differences in the Harris hip score (p = 0.545), the timed up and go test (p = 0.298), the Tinetti test (p = 0.381) or the Barthel Index (p = 0.094) between patients with Kellgren and Lawrence grades 3 or 4 osteoarthritis, and patients with grades 0 to 2 changes. Furthermore, there were no differences in complication or revision rates. CONCLUSIONS Our findings challenge the hypothesis that pre-existing osteoarthritis is a contraindication to hemiarthroplasty in elderly patients with femoral neck fracture.
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Affiliation(s)
- Christoph Kolja Boese
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931, Cologne, Germany.
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Michael Frink
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Philipp Lechler
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
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Yoon PW, Lee YK, Ahn J, Jang EJ, Kim Y, Kwak HS, Yoon KS, Kim HJ, Yoo JJ. Epidemiology of hip replacements in Korea from 2007 to 2011. J Korean Med Sci 2014; 29:852-8. [PMID: 24932089 PMCID: PMC4055821 DOI: 10.3346/jkms.2014.29.6.852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/10/2014] [Indexed: 11/20/2022] Open
Abstract
We analyzed national data collected by the Health Insurance Review and Assessment Service in Korea from 2007 to 2011; 1) to document procedural numbers and procedural rate of bipolar hemiarthroplasty (BH), primary and revision total hip arthroplasties (THAs), 2) to stratify the prevalence of each procedure by age, gender, and hospital type, and quantified, 3) to estimate the revision burden and evaluate whether the burden is changed over time. Our final study population included 60,230 BHs, 40,760 primary THAs, and 10,341 revision THAs. From 2007 to 2011, both the number and the rate of BHs, primary THAs increased steadily, whereas there was no significant change in revision THAs. Over the 5 yr, the rate of BHs and primary THAs per 100,000 persons significantly increased by 33.2% and 21.4%, respectively. The number of revision THAs was consistent over time. The overall annual revision burden for THA decreased from 22.1% in 2007 to 18.9% in 2011. In contrast to western data, there were no changes in the number and rate of revision THAs, and the rates of primary and revision THAs were higher for men than those for women. Although 5 yr is a short time to determine a change in the revision burden, there have been significant decreases in some age groups.
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Affiliation(s)
- Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeonghoon Ahn
- Office of Health Services Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Eun Jin Jang
- Office of Health Services Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of Information Statistics, Andong National University, Andong, Korea
| | - Yunjung Kim
- Office of Health Services Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Hong Suk Kwak
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Seoul National University, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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