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Jacob N, Ghobrial M, Parker M. Answer to the letter to the editor "Does delay from injury to surgery increase the risk of dislocation of a hip hemiarthroplasty?". Injury 2024; 55:111832. [PMID: 39357195 DOI: 10.1016/j.injury.2024.111832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Affiliation(s)
- Neville Jacob
- Trauma and Orthopaedic Surgery, Peterborough City Hospital, North West Anglia NHS Trust, United Kingdom.
| | - Marios Ghobrial
- Trauma and Orthopaedic Surgery, Peterborough City Hospital, North West Anglia NHS Trust, United Kingdom
| | - Martyn Parker
- Trauma and Orthopaedic Surgery, Peterborough City Hospital, North West Anglia NHS Trust, United Kingdom
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Iwasa M, Ando W, Takashima K, Uemura K, Hamada H, Sugano N. Effects of Cerclage Cabling on Preventing Periprosthetic Femoral Fractures When Using Cementless Stems for Unstable Femoral Neck Fractures. J Arthroplasty 2024; 39:2807-2811. [PMID: 38735547 DOI: 10.1016/j.arth.2024.04.085] [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: 11/23/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Periprosthetic femoral fractures (PFFs) are serious complications in hip arthroplasty for femoral neck fractures. The rates of intraoperative (iPFFs) and postoperative PFFs (pPFFs) are higher in cementless stem cases than in cemented cases. This study aimed to investigate the effects of cerclage cabling on PFF prevention in cementless arthroplasty for femoral neck fractures. METHODS This retrospective study included 329 consecutive patients who underwent hip arthroplasty using a cementless stem for femoral neck fractures. A total of 159 and 170 patients were in the non-cabling and cabling groups, respectively. Patient characteristics were comparable in both groups. The PFF occurrence (iPFF and pPFF) rates, reoperation rates, operative time, and blood loss volume were compared between the groups. RESULTS The iPFF rate was significantly higher in the noncabling group (6.3%) than in the cabling group (0%, P < .001). The rate of pPFF was significantly higher in the non-cabling group (5.1%) than in the cabling group (0.6%; P = .016). All patients in the non-cabling group required reoperation (5.1%), whereas the patient in the cabling group was an ambulatory case and required no reoperation (0%, P = .003). No significant difference in either operative time or blood loss volume was observed between the non-cabling (50 minutes, 133 mL) and cabling (52 minutes, P = .244; 149 mL, P = .212, respectively) groups. CONCLUSIONS When a cementless stem is used to treat unstable femoral neck fractures, cerclage cabling effectively prevents iPPF and pPPF without increasing surgical time or blood loss volume.
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Affiliation(s)
- Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan; Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki City, Hyogo, Japan
| | - Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
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Moore J, Berney M, Walsh M, Hurson C, Rowan F, Cleary M, Brent L. Intracapsular hip fractures: A comparative study of cemented and uncemented hemiarthroplasties in the Irish hip fracture database. Surgeon 2024; 22:276-280. [PMID: 38135630 DOI: 10.1016/j.surge.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The aim of this study was to analyse the association between use of cement for stem fixation in hip hemiarthroplasty and the outcomes of mobility, mortality, and discharge destination. METHODS The Irish Hip Fracture Database was examined from 2016 to 2020 to assess for any difference in post op mobility, 7-day, 14-day and inpatient mortality, and discharge destination. RESULTS A total of 7109 hemi-arthroplasties were identified from 2016 to 2020. 71.6 % were cemented (n = 5,172), with 28.4 % uncemented (1,937). There was no difference in day 1 post op mobilisation (79.7 % vs 80.9 %) or cumulative ambulatory score on discharge (2.5 vs 2.4). The mortality rate was equivocal at all time points between the cemented and uncemented groups (7 day (.9 % vs 1.2 %), 14 day (1.9 % vs 2.3 %), inpatient (4 % vs 5.1 %)). There was no difference in length of stay (11 vs 12 days) or discharge to home directly (21 % vs 27 %). CONCLUSION The use of cement did not have any significant difference on post op mortality, mobility or discharge destination.
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Affiliation(s)
- Joss Moore
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland.
| | - Mark Berney
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Mary Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Conor Hurson
- St Vincent's University Hospital, Dublin, Ireland
| | - Fiachra Rowan
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - May Cleary
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, Ireland
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Webb ML. CORR Insights®: Can Bisphosphonate Therapy Reduce Overall Mortality in Patients With Osteoporosis? A Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res 2024:00003086-990000000-01753. [PMID: 39348317 DOI: 10.1097/corr.0000000000003255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 09/03/2024] [Indexed: 10/02/2024]
Affiliation(s)
- Matthew L Webb
- Orthopaedic Surgeon, Bone and Joint Clinic, St Tammany Parish Hospital, Covington, LA, USA
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Keeney JA. CORR Insights®: Are There Differences in Performance Among Femoral Stem Brands Utilized in Cementless Hemiarthroplasty for Treatment of Geriatric Femoral Neck Fractures? Clin Orthop Relat Res 2024:00003086-990000000-01750. [PMID: 39330916 DOI: 10.1097/corr.0000000000003266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024]
Affiliation(s)
- James A Keeney
- Vice Chairman and Professor, Orthopaedic Surgery Department, University of Missouri, Columbia, MO, USA
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Feng Y, Wan J, Deng H, Chen L, Xiao Y, Li T, He J, Wang P, Chong W, Hai Y, Jia L, Zhang Y. Effect of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly: A meta-analysis of randomized clinical trials. Medicine (Baltimore) 2024; 103:e39562. [PMID: 39287288 PMCID: PMC11404976 DOI: 10.1097/md.0000000000039562] [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: 10/18/2023] [Revised: 05/07/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024] Open
Abstract
PURPOSE In patients undergoing hemiarthroplasty in the elderly, the choice of the cemented method remains controversial. This meta-analysis was undertaken to compare the impact of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly. METHODS This study included randomized controlled trials comparing the postoperative effects of cemented vs uncemented in patients with hemiarthroplasty. With no language restrictions, we searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Cochrane Collaboration), Clinical Trials.gov, the ISRCTN registry, as well as gray literature with no language restrictions from January 1966 to April 2023. Data were quantitatively summarized using a random-effects model. The primary outcome was 1-year mortality. RESULTS This study included 13 randomized controlled trials with 3485 patients. The primary outcomes of the meta-analysis showed that cemented fixation in elderly patients undergoing hemiarthroplasty was superior to noncemented in 1-year mortality (risk ratio [RR] = 0.87, 95% confidence interval [CI]: 0.77, 0.97). Moreover, cemented was associated with a reduced risk of intraoperative periprosthetic fracture (RR = 0.19, 95% CI: 0.07, 0.50), postoperative periprosthetic fracture (RR = 0.34, 95% CI: 0.16,0.72), and loosening (RR = 0.33, 95% CI: 0.11, 0.97). CONCLUSIONS Cemented hemiarthroplasty is superior to noncemented in terms of survival. Moreover, cementation reduces the incidence of some implant-related complications. More extensive trials are needed to provide adequate guidance for choosing the proper cemented method.
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Affiliation(s)
- Yuning Feng
- Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Jun Wan
- Chengdu University School of Medicine, Chengdu, China
| | - Haidong Deng
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Department of Anesthesia, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Yu Zhang
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
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Rivera F, Comba LC, Colombo M, Benazzo F, Cavaliere P, Solarino G. Management of intracapsular hip fracture: Current trends from a national survey. Injury 2024; 55 Suppl 4:111539. [PMID: 39542582 DOI: 10.1016/j.injury.2024.111539] [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: 11/24/2023] [Revised: 03/08/2024] [Accepted: 04/01/2024] [Indexed: 11/17/2024]
Abstract
Proximal femoral fractures are a major public health issue due to an increasing ageing population, with an important impact on patients' quality of life. This study was designed by the Authors through a national survey with the purpuse to investigate the italian experience and practice about management and perioperative/operative trends of intracapsular proximal femoral fractures (PFF). In February-March 2022 a national survey was submitted online to the members of SIOT (Società Italiana Ortopedici e Traumatologi) and SIDA (Società Italiana dell'Anca) societies. Demographic data of the participants such as age, type of workplace and years of working experiences were registered. The questionnarie included 21 multiple choice questions about: demographic data, preoperative management, surgical indications (treatment of non-displaced and displaced fractures), management of the geriatric patient and surgical technique. Resulting data were collected and stored in a database, the results were then processed and compared with the international literature and registries. The Survey was completed by 372 surgeons; answers reported were often in accordance with the literature and national and international guidelines, with, on the other hand, important controversies regarding preoperative management (radiological studies and preoperative planning), some surgical indications and choice of stem fixation. Management of proximal femoral fractures is not always clear and univocal; it is mandatory to produce a diagnostic-therapeutic process supported by scientific evidence. In this context the SIOT Guidelines 2021 offer a real help for the surgeon managing a PPF.
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Affiliation(s)
- Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | - Luca Costanzo Comba
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy.
| | - Massimiliano Colombo
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy
| | | | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Messina, Italy
| | - Giuseppe Solarino
- Orthopaedics Unit, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
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Kamo K. The Superior Approach in Hemiarthroplasty for Femoral Neck Fracture: A Comparative Analysis with the Posterior Approach. Hip Pelvis 2024; 36:211-217. [PMID: 39210574 PMCID: PMC11380541 DOI: 10.5371/hp.2024.36.3.211] [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: 11/17/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose The concept of a superior approach (SA) involves the use of a tissue-sparing posterior approach (PA), with exposure of the piriformis muscle and gluteus medius/minimus muscles. The objective of this study was to clarify the features of hip hemiarthroplasty (HA) using a SA in regard to early recovery and mid-term outcomes, with a comparison of the outcomes of SA-HAs and HAs using a PA (PA-HAs). Materials and Methods A total of 120 HAs for treatment of primary femoral neck fracture with a healthy opposite hip joint were performed in our hospital from 2013 to 2018. Propensity score matching in regard to age, sex, body mass index, walking ability before injury, place of residence, time to surgery, and American Society of Anesthesiologists-Physical Status was performed for 79 patients with SA-HAs and 41 patients with PA-HAs. The final analysis included 34 patients who underwent SA-HAs and 34 patients who underwent PA-HAs. Results The duration of surgery was 57.1 minutes and 72.1 minutes (P=0.001) for SA-HAs and PA-HAs, respectively. The scores for walking ability at postoperative one week were 4.9±1.4 and 4.2±1.0 (P=0.021) for SA-HAs and PA-HAs, respectively. The Barthel index (BI) at the start of rehabilitation was 26.2±18.7 and 17.4±16.3 (P=0.042) for SA-HAs and PA-HAs, respectively. The 4-year complication-free survival rates were 74.2% and 56.3% for SA-HAs and PA-HAs, respectively (P=0.310). Conclusion SA-HA can be performed without torsion of the muscles and ligaments around the hip joint. Early recovery of walking ability and BI was a significant feature of SA-HAs.
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Affiliation(s)
- Kenta Kamo
- Department of Orthopaedics Surgery, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
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9
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Hole RM, Fenstad AM, Gjertsen JE, Hallan G, Furnes ON. Influence of design features and brand of reverse shoulder arthroplasties on survivorship and reasons for revision surgery: results of 5,494 arthroplasties with up to 15 years' follow-up reported to the Norwegian Arthroplasty Register 2007-2022. Acta Orthop 2024; 95:463-471. [PMID: 39189259 PMCID: PMC11348804 DOI: 10.2340/17453674.2024.41344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to report the survival of different reverse shoulder arthroplasty (RSA) designs and brands, and factors associated with revision. The secondary aim was to evaluate the reasons for revision. METHODS We included 4,696 inlay and 798 onlay RSAs reported to the Norwegian Arthroplasty Register (NAR) 2007-2022. Kaplan-Meier estimates of survivorship and Cox models adjusted for age, sex, diagnosis, implant design, humeral fixation, and previous surgery were investigated to assess revision risks. The reasons for revision were compared using competing risk analysis. RESULTS Overall, the 10-year survival rate was 94% (confidence interval [CI] 93-95). At 5 years all brands exceeded 90%. Compared with Delta Xtend (n = 3,865), Aequalis Ascend Flex (HR 2.8, CI 1.7-4.6), Aequalis Reversed II (HR 2.2, CI 1.2-4.2), SMR (HR 2.5, CI 1.3-4.7), and Promos (HR 2.2, CI 1.0-4.9) had increased risk of revision. Onlay and inlay RSAs had similar risk of revision (HR 1.2, CI 0.8-1.8). Instability and deep infection were the most frequent revision causes. Male sex (HR 2.3, CI 1.7-3.1), fracture sequelae (HR 3.1, CI 2.1-5.0), and fractures operated on with uncemented humeral stems had increased risk of revision (HR 3.5, CI 1.6-7.3). CONCLUSION We found similar risk of revision with inlay and onlay designs. Some prosthesis brands had a higher rate of revision than the most common implant, but numbers were low.
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Affiliation(s)
- Randi M Hole
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ove N Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Leino OK, Forsbacka N, Laaksonen IE, Mäkelä KT, Matilainen M, Ekman EM. Changing treatment of hip fractures in Finland. Arch Orthop Trauma Surg 2024; 144:3469-3478. [PMID: 39196404 PMCID: PMC11417085 DOI: 10.1007/s00402-024-05462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 07/11/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Hip fracture treatment should be as standardized and effective as possible, with emphasis on fast recovery and avoidance of complications, especially those leading to reoperations. There is accumulating evidence regarding the optimal treatment of hip fractures but reports of whether this has influenced treatment in the clinical setting are sparse. The objective of this study was to determine the trends of hip fracture incidence and treatment in Finland, with special regard to how we treat older patients compared to younger ones. MATERIALS AND METHODS All operatively treated hip fractures in Finland between 1997 and 2018 were identified from a national administrative register. The incidence of these fractures and operations performed to treat them were calculated based on the adult population size. RESULTS Apart from a decline in the elderly age groups during the first half of the study period, the incidence of hip fractures remained relatively constant. However, the incidences of different operations changed significantly. In treatment of femoral neck fractures from 1997 to 2018, the incidence of cemented hemiarthroplasty (HA) increased from 41.1 to 59.9 per 100,000 person-years (105) and hybrid total hip arthroplasty (THA) from 0.56 to 5.93 per 105, while the incidence of internal fixation (IF) decreased, for instance screw fixation from 12.5 to 2.7 per 105. The incidence of cementless HA decreased from 13.3 to 1.2 per 105. These changes were much more pronounced in the elderly population and there was a statistically significant difference in the proportion of patients aged > 59 treated with cemented HA and IF in 1997 compared to 2018. For trochanteric and subtrochanteric fractures, treatment with intramedullary nails replaced extramedullary devices as the most common treatment method. CONCLUSIONS The changes in treatment methods in Finland correspond to the increasing knowledge available about the optimal treatment of hip fractures and global treatment trends.
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Affiliation(s)
- Oskari K Leino
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Nora Forsbacka
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| | - Inari E Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
| | - Markus Matilainen
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Elina M Ekman
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
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Wang X, Zhao X. Letter to the editor regarding "Does delay from injury to surgery increase the risk of dislocation of a hip hemiarthroplasty?". Injury 2024; 55:111581. [PMID: 38677179 DOI: 10.1016/j.injury.2024.111581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Xinjie Wang
- Department of Clinic Medicine, Jining Medical University, Jining, Shandong, 272067, PR China
| | - Xiaowei Zhao
- Department of Joint and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272029, PR China.
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Magnusson J, Karlsson J, Sköldenberg O, Albert J, Frostell C, Jakobsson JG. Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013-2022. J Orthop Surg Res 2024; 19:295. [PMID: 38750567 PMCID: PMC11094893 DOI: 10.1186/s13018-024-04752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status. AIM To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques. MATERIALS AND METHODS Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden. RESULTS In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3-5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9-2.3, p < 0.001). CONCLUSIONS All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.
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Affiliation(s)
| | - J Karlsson
- Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - O Sköldenberg
- Unit of Orthopaedics, Department of clinical sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Albert
- Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden
| | - C Frostell
- Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden
| | - J G Jakobsson
- Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden.
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Zügner R, Tranberg R, Sharegi B, Kärrholm J. Gait pattern in patients treated with a total hip arthroplasty due to an acute displaced cervical neck fracture: a randomised comparison between 29 cases with a cemented femoral stem and 16 cases with an uncemented femoral stem. Hip Int 2024; 34:421-427. [PMID: 38087800 PMCID: PMC11071595 DOI: 10.1177/11207000231208099] [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: 02/11/2023] [Accepted: 08/08/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The choice between cemented or uncemented stem fixation in the treatment of a femoral neck fracture may influence patient rehabilitation and the resulting gait pattern, due to potential differences in implant positioning and fixation. We used gait analysis to study temporal gait parameters, hip kinematics and kinetics in patients who, 2 years previously, had been randomised to treatment with a cemented or uncemented stem and due to an acute femoral neck fracture. METHODS 45 Patients implanted with a cemented Lubinus SP II (n = 29) and an uncemented (n = 16) Corail stem were studied. Gait analysis was performed using a 16-camera motion capture system and force plates. 28 subjects served as controls. Temporal gait parameters, hip kinematics and kinetics were analysed. The patients had no or minimum pain (median Harris pain score 44, range 40-44) and the majority had no limp (median Harris limp score 11, range 5-11). RESULTS Temporospatial gait parameters and abduction-adduction motions and moments did not differ between patients with cemented or uncemented stems (p > 0.05). Patients with cemented stems did, however, show more hip flexion and less extension during walking than those with an uncemented stem (p < 0.05). Moreover, the flexion-extension range was less in the cemented group (p < 0.04). Compared with controls, the hip fracture patients walked more slowly, with a shorter stride length and a longer stance phase. CONCLUSIONS Increased hip flexion and reduced extension in patients using the Lubinus SP II cemented stem could be an effect of its anteverted neck, but this question requires further study. Despite acute treatment with THA, hip fracture patients demonstrated a change in gait pattern compared with controls 2 years after the operation. This suggests that these changes are caused by the presence of an implant, or the soft-tissue trauma partly caused by the surgery than by any degenerative disease present in patients undergoing elective surgery.ClinicalTrials.gov Identifier: NCT04791605.
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Affiliation(s)
- Roland Zügner
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Bita Sharegi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
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14
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Esper GW, Meltzer-Bruhn AT, Anil U, Schwarzkopf R, Macaulay W, Konda SR, Ganta A, Egol KA. Periprosthetic fracture following arthroplasty for femoral neck fracture: is a cemented stem protective? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1927-1935. [PMID: 38462554 DOI: 10.1007/s00590-023-03830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Periprosthetic femoral fractures (PFF) carry significant morbidity following arthroplasty for femoral neck fracture (FNF). This study assessed fracture complications following arthroplasty for FNF and the effect of cement fixation of the femoral component on intraoperative and post-operative PFF. METHODS Between February 2014 and September 2021, 740 patients with a FNF who underwent arthroplasty were analyzed for demographics, surgical management, use of cement for fixation of the femoral component, and subsequent PFF. Variables were compared with Mann-Whitney or Chi-square as appropriate. Multivariate logistic regression was used to assess independent risk factors associated with intraoperative or post-operative PFF. RESULTS There were 163 THAs (41% cemented) and 577 HAs (95% cemented). There were 28 PFFs (3.8%): 18 post-operative and 10 intraoperative. Fewer post-operative PFFs occurred with cemented stems (1.63% vs. 6.30%, p = 0.002). Mean time from surgery to presentation with post-operative PFF was 14 months (0-45 months). Mean follow-up time was 10.3 months (range: 0-75.7 months). In multivariate regression, use of cement and THA was independently associated with decreased post-operative PFF (cement: OR 0.112, 95% CI 0.036-0.352, p < 0.001 and THA: OR 0.249, 95% CI 0.064-0.961, p = 0.044). More intraoperative fractures occurred during THA (3.68% vs. 0.69%, p = 0.004) and non-cemented procedures (5.51% vs. 0.49%, p < 0.001). In multivariate regression, use of cement was protective against intraoperative fracture (OR 0.100, CI 0.017-0.571, p = 0.010). CONCLUSIONS In patients with a FNF treated with arthroplasty, cementing the femoral component is associated with a lower risk of intraoperative and post-operative PFF. Choice of procedure may be based on patient factors and surgeon preference.
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Affiliation(s)
- Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Utkarsh Anil
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - William Macaulay
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
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15
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Wang Z, Wishman MD, Tutaworn T, Hentschel IG, Levin JE, Lane JM. Osteoporosis and cement usage in total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1649-1655. [PMID: 38374483 DOI: 10.1007/s00590-024-03855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Cement usage in total hip arthroplasty (THA) is increasingly common. However, osteoporosis-related fracture risk in cemented vs uncemented THA patients is poorly characterized. We aim to analyze the usage of metabolic bone care and osteoporosis fracture risk in cemented vs uncemented THA patients using FRAX and radiographic bone measurements. METHODS Chart review on 250 THA patients was performed retrospectively. Demographics, FRAX scores, hip radiograph measurements, osteoporosis diagnosis, treatment and screening were compared between cemented and uncemented THA patients. Logistic regression model was used to analyze factors influencing cement usage. RESULTS Cemented THA patients have significantly higher osteoporosis-related fracture risk as measured by FRAX major (20% vs 13%) and FRAX hip (8% vs 5%). There is no significant difference in osteoporosis treatment, vitamin D / calcium supplementation, or metabolic bone disease screening based on patients' cement status. Female sex and rheumatoid arthritis status significantly predict cement usage, but FRAX scores do not predict cement usage. Additionally, 50% (10/20) of patients with Dorr C classification were uncemented. CONCLUSION Although some patients undergoing THA with high osteoporosis-related fracture risk were identified and cemented, some risk factors including poor proximal femur shape (by Dorr classification) and poor bone quality (as measured by FRAX score) were potentially overlooked. Cemented patients had an increased risk for fractures but did not receive appropriately increased osteoporosis screening or treatment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zhaorui Wang
- Weill Cornell Medical College, 1300 York Ave., New York, NY, USA
| | - Mark D Wishman
- Weill Cornell Medical College, 1300 York Ave., New York, NY, USA.
| | - Teerapat Tutaworn
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70 St, New York, NY, USA
| | - Isabelle G Hentschel
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70 St, New York, NY, USA
| | - Justin E Levin
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70 St, New York, NY, USA
| | - Joseph M Lane
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70 St, New York, NY, USA
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16
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Ibaseta A, Emara A, Rullán PJ, Santana DC, Ng MK, Grits D, Krebs VE, Molloy RM, Piuzzi NS. Effect of operative time in outcomes following surgical fixation of hip fractures: a multivariable regression analysis of 35,710 patients. Hip Int 2024; 34:270-280. [PMID: 37795582 DOI: 10.1177/11207000231203527] [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] [Indexed: 10/06/2023]
Abstract
BACKGROUND Prolonged operative time is a risk factor for increased morbidity and mortality after open reduction and internal fixation (ORIF) of hip fractures. However, the quantitative nature of such association, including graduated risk levels, has yet to be described. This study outlines the graduated associations between operative time and (1) healthcare utilisation, and (2) 30-day complications after ORIF of hip fractures. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried (January 2016-December 2019) for all patients who underwent ORIF of hip fractures (n = 35,710). Demographics, operative time, fracture type, and comorbidities were recorded. Outcomes included healthcare utilisation (e.g., prolonged length of stay [LOS>2 days], discharge disposition, 30-day readmission, and reoperation), inability to weight-bear (ITWB) on postoperative day-1 (POD-1), and any 30-day complication. Adjusted multivariate regression models evaluated associations between operative time and measured outcomes. RESULTS Operative time <40 minutes was associated with lower odds of prolonged LOS (odds ratio [OR] 0.77), non-home discharge (OR 0.85), 30-day readmission (OR 0.85), and reoperation (OR 0.72). Operative time ⩾80 minutes was associated with higher odds of ITWB on POD-1 (OR 1.17). Operative time ⩾200 minutes was associated with higher odds of deep infection (OR 7.5) and wound complications (OR 3.2). The odds of blood transfusions were higher in cases ⩾60 minutes (OR1.3) and 5-fold in cases ⩾200 minutes (OR 5.4). The odds of venous thromboembolic complications were highest in the ⩾200-minute operative time category (OR 2.5). Operative time was not associated with mechanical ventilation, pneumonia, delirium, sepsis, urinary tract infection, or 30-day mortality. DISCUSSION Increasing operative time is associated with a progressive increase in the odds of adverse outcomes following hip fracture ORIF. While a direct cause-effect relationship cannot be established, an operative time of <60 minutes could be protective. Perioperative interventions that shorten operative time without compromising fracture reduction or fixation should be considered.
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Affiliation(s)
- Alvaro Ibaseta
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ahmed Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Pedro J Rullán
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel C Santana
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mitchell K Ng
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Grits
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Viktor E Krebs
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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17
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Gjertsen JE, Nilsen D, Furnes O, Hallan G, Kroken G, Dybvik E, Fenstad AM. Promoting cemented fixation of the femoral stem in elderly female hip arthroplasty patients and elderly hip fracture patients: a retrospective cohort study from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register. Acta Orthop 2024; 95:130-137. [PMID: 38391278 PMCID: PMC10885817 DOI: 10.2340/17453674.2024.40073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population. METHODS 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015-2017 and 2019-2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan-Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint. RESULTS The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015-2017 to 2.1% in 2019-2021 (aHRR 0.7, 95% confidence interval [CI] 0.5-0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015-2017 to 3.3% in 2019-2021 (aHRR 0.6, CI 0.4-0.8) at the intervention hospitals. CONCLUSION The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.
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Affiliation(s)
- Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen.
| | - Daniel Nilsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Gard Kroken
- Directorate of Fisheries, Section for Analysis and Risk Assessment, Bergen, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
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18
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Moon TJ, Blackburn CW, Du JY, Marcus RE. What Are the Differences in Hospital Cost Associated With the Use of Cemented Versus Cementless Femoral Stems in Hemiarthroplasty and Total Hip Arthroplasty for the Treatment of Femoral Neck Fracture? J Arthroplasty 2024; 39:313-319.e1. [PMID: 37572717 DOI: 10.1016/j.arth.2023.08.017] [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: 01/07/2023] [Revised: 05/29/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine if there is a difference in hospital costs associated with the use of cemented versus cementless femoral stems in hemiarthroplasty (HA) and total hip arthroplasty (THA) for the treatment of femoral neck fracture (FNF). METHODS This retrospective cohort study utilizes the 2019 Medicare Provider Analysis and Review Limited Data Set. Patients undergoing arthroplasty for the treatment of FNF were identified. Patients were grouped by cemented or cementless femoral stem fixation. There were 16,148 patients who underwent arthroplasty for FNF available: 4,913 THAs (3,705 patients who had cementless femoral stems and 1,208 patients who had cemented femoral stems) and 11,235 HAs (6,099 patients who had cementless femoral stems and 5,136 who had cemented femoral stems). Index hospital costs were estimated by multiplying total charges by cost-to-charge ratios. Costs were analyzed using univariable and multivariable generalized linear models. RESULTS Cemented femoral stem THA generated 1.080 times (95% confidence interval, 1.06 to 1.10; P < .001), or 8.0%, greater index hospital costs than cementless femoral stem THA, and cemented femoral stem HA generated 1.042 times (95% confidence interval, 1.03 to 1.05; P < .001), or 4.2%, greater index hospital costs than cementless femoral stem HA. CONCLUSIONS Cemented femoral stems for FNF treated with either THA or HA are associated with only a small portion of increased cost compared to cementless femoral stems. Providers may choose the method of arthroplasty stem fixation for the treatment of FNF based on what they deem most appropriate for the specific patient.
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Affiliation(s)
- Tyler J Moon
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Collin W Blackburn
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jerry Y Du
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Randall E Marcus
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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19
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Schmitz PP, Somford MP, Jameson SS, Schreurs BW, van Susante JLC. Controversies around hip fracture treatment: clinical evidence versus trends from national registries. Hip Int 2024; 34:144-151. [PMID: 37313801 DOI: 10.1177/11207000231177642] [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] [Indexed: 06/15/2023]
Abstract
PURPOSE Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice. METHODS A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand). RESULTS For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries. CONCLUSIONS Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved.
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Affiliation(s)
- Peter P Schmitz
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Simon S Jameson
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
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20
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Bloemheuvel EM, van Steenbergen LN, Swierstra BA, Schreurs BW. Revision Risk of Unipolar and Bipolar Hemiarthroplasties in the Dutch Arthroplasty Register. J Arthroplasty 2024; 39:118-123. [PMID: 37454950 DOI: 10.1016/j.arth.2023.07.006] [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: 12/27/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) for hip fractures can be performed with a unipolar or bipolar head. We describe the use of unipolar and bipolar HA after a hip fracture in the Netherlands and determined revision rates and risk factors. METHODS All HAs for an acute hip fracture registered in the Dutch Arthroplasty Register (LROI) during 2007 to 2021 were included; 44,127(88%) unipolar and 6,013(12%) bipolar HAs. Competing risk survival analyses were performed with revision for any reason as the endpoint. Multivariable Cox regression analyses were performed adjusting for patient and surgery-related factors. RESULTS The 1-year, 5-year, and 10-year revision rates were comparable for unipolar and bipolar HA. Cox regression analysis showed a hazard ratio of 1.2 (95% confidence interval (CI) 1.0 to 1.4)) after adjustment for confounders for bipolar heads. In cases of a cemented stem, the 1-year cumulative incidence of revision was lower (1.5% (CI 1.4 to 1.7%) compared to uncemented stems (2.4% (CI 2.1 to 2.7%); uncemented stems showed higher risks for revision after adjustment compared to cemented stems (hazard ratio 1.4 (CI 1.2 to 1.5)). The anterior, antero-lateral, and straight-lateral approach showed lower risk for revision compared to the postero-lateral approach. CONCLUSION The revision rate for bipolar HA and unipolar HA was comparable. However, after adjustment for potential confounders the risk for revision showed an estimated 20% increased revision risk for bipolar heads, although not statistically significant. For both head types, the risk for revision was significantly higher when an uncemented stem was chosen or the postero-lateral approach was used.
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Affiliation(s)
- Esther M Bloemheuvel
- Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Bart A Swierstra
- Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
| | - Berend W Schreurs
- Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
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21
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Xu Z, Zhang K, Cheng K, Sun G, Zhang Y, Jia J. A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures. Int Wound J 2023; 20:4122-4129. [PMID: 37555547 PMCID: PMC10681411 DOI: 10.1111/iwj.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023] Open
Abstract
To providing evidence-based recommendations for surgery in patients with femoral neck fractures, a meta-analysis was conducted to comprehensively evaluate the effects of cemented and uncemented prostheses on postoperative surgical site wound infection and pain in these patients. Relevant studies on the use of cemented prostheses in femoral neck fractures were retrieved from PubMed, EMBASE, Cochrane Library, Ovid, CNKI, and Wanfang databases from the time of their establishment until March 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Review Manager 5.4 software was used to perform meta-analyses on the collected data. A total of 27 articles comprising 34 210 patients (24 646 cases in the cemented group and 9564 cases in the uncemented group) were included in the final analysis. The results of the meta-analysis showed that, compared with the uncemented group, cemented prostheses significantly reduced the incidence of surgical site wound infections (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.64-0.88, p < 0.001) and relieved surgical site wound pain (standardised mean difference: -0.76, 95% CI: -1.12-0.40, p < 0.001), but did not reduce the incidence of pressure ulcers after surgery (OR: 0.50, 95% CI: 0.20-1.26, p = 0.140). Therefore, existing evidence suggests that the use of cemented prostheses in femoral neck fracture surgery can significantly reduce the incidence of surgical site wound infections and relieve surgical site wound pain, which is worthy of clinical recommendation.
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Affiliation(s)
- Ze Xu
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Ke Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Kai Cheng
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Guangwei Sun
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Yaning Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Jian Jia
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
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22
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Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany: an analysis from the German Arthroplasty Registry (EPRD). J Orthop Traumatol 2023; 24:9. [PMID: 36811821 PMCID: PMC9947202 DOI: 10.1186/s10195-023-00689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Femoral neck fractures (FNF) are among the most common fractures in Germany and are often treated by hemiarthroplasty (HA). The aim of this study was to compare the occurrence of aseptic revisions after cemented and uncemented HA for the treatment of FNF. Secondly, the rate of pulmonary embolism was investigated. METHODS Data collection for this study was performed using the German Arthroplasty Registry (EPRD). HAs after FNF were divided into subgroups stratified by stem fixation (cemented vs uncemented) and paired according to age, sex, BMI, and the Elixhauser score using Mahalanobis distance matching. RESULTS Examination of 18,180 matched cases showed a significantly increased rate of aseptic revisions in uncemented HA (p < 0.0001). After 1 month 2.5% of HAs with uncemented stems required an aseptic revision, while 1.5% were reported in cemented HA. After 1 and 3 years' follow-up 3.9% and 4.5% of uncemented HA and 2.2% and 2.5% of cemented HA needed aseptic revision surgery. In particular, the proportion of periprosthetic fractures was increased in cementless implanted HA (p < 0.0001). During in-patient stays, pulmonary emboli occurred more frequently after cemented HA [0.81% vs 0.53% in cementless HA (OR: 1.53; p = 0.057)]. CONCLUSION For uncemented hemiarthroplasties a statistically significantly increased rate of aseptic revisions and periprosthetic fractures was evident within a time period of 5 years after implantation. During the in-hospital stay, patients with cemented HA experienced an increased rate of pulmonary embolism, but without statistically significant results. Based on the present results, with knowledge of prevention measurements and correct cementation technique, cemented HA should be preferred when using HA in the treatment of femoral neck fractures. TRAIL REGISTRATION The study design of the German Arthroplasty Registry was approved by the University of Kiel (ID: D 473/11). LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Dominik Szymski
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Nike Walter
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Paula Krull
- Deutsches Endoprothesenregister gGmbH (EPRD), Berlin, Germany
| | | | | | - Volker Alt
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Arnd Steinbrück
- Deutsches Endoprothesenregister gGmbH (EPRD), Berlin, Germany ,Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. [Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany : An analysis from the Germany Arthroplasty Registry (EPRD)]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04412-3. [PMID: 37422578 DOI: 10.1007/s00132-023-04412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Femoral neck fractures (FNF) are among the most common fractures in Germany and are often treated by hemiarthroplasty (HA). The aim of this study was to compare the occurrence of aseptic revisions after cemented and uncemented HA for the treatment of FNF. Secondly, the rate of pulmonary embolism was investigated. METHODS Data collection for this study was performed using the German Arthroplasty Registry (EPRD). HAs after FNF were divided into subgroups stratified by stem fixation (cemented vs uncemented) and paired according to age, sex, BMI, and the Elixhauser score using Mahalanobis distance matching. RESULTS Examination of 18,180 matched cases showed a significantly increased rate of aseptic revisions in uncemented HA (p < 0.0001). After 1 month 2.5% of HAs with uncemented stems required an aseptic revision, whereas 1.5% were reported in cemented HA. After 1 and 3 years' follow-up 3.9% and 4.5% of uncemented HA and 2.2% and 2.5% of cemented HA needed aseptic revision surgery. In particular, the proportion of periprosthetic fractures was increased in cementless implanted HA (p < 0.0001). During in-patient stays, pulmonary emboli occurred more frequently after cemented HA (0.81% vs 0.53% in cementless HA [OR: 1.53; p = 0.057]). CONCLUSION For uncemented hemiarthroplasties a statistically significantly increased rate of aseptic revisions and periprosthetic fractures was evident within a time period of 5 years after implantation. During the in-hospital stay, patients with cemented HA experienced an increased rate of pulmonary embolism compared with patients with cementless HA, but this difference was not statistically significant. Based on the present results, with knowledge of prevention measures and the correct cementation technique, the use of cemented HA should be preferred in the treatment of femoral neck fractures.
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Affiliation(s)
- Dominik Szymski
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Nike Walter
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Paula Krull
- Endoprothesenregister Deutschland gGmbH (EPRD), Berlin, Deutschland
| | | | | | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Arnd Steinbrück
- Endoprothesenregister Deutschland gGmbH (EPRD), Berlin, Deutschland
- Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Deutschland
| | - Markus Rupp
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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Hoseth JM, Aae TF, Jakobsen RB, Fenstad AM, Bukholm IRK, Gjertsen JE, Randsborg PH. Compensation Claims After Hip Fracture Surgery in Norway 2008-2018. Geriatr Orthop Surg Rehabil 2023; 14:21514593231188623. [PMID: 37435443 PMCID: PMC10331336 DOI: 10.1177/21514593231188623] [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: 01/21/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background Surgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications. Methods We collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location. Results 90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities. Discussion The fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims. Conclusions Our findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.
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Affiliation(s)
- John Magne Hoseth
- Department of Orthopaedic Surgery, Kristiansund Hospital, Health Møre and Romsdal HF, Kristiansund, Norway
- Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Tommy Frøseth Aae
- Department of Orthopaedic Surgery, Kristiansund Hospital, Health Møre and Romsdal HF, Kristiansund, Norway
- Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Health and Society, The Medical Faculty, University of Oslo Department of Health Management and Health Economics, Oslo, Norway
| | - Anne Marie Fenstad
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. Hip Fracture Care during COVID-19: Evolution through the Pandemic. Cureus 2023; 15:e42696. [PMID: 37654921 PMCID: PMC10465306 DOI: 10.7759/cureus.42696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The purpose of this epidemiologic study was to analyze the care provided by our institution to middle-aged and geriatric hip fracture patients throughout the pandemic to examine for any differences compared to pre-pandemic care and across the pandemic stages. METHODS Consecutive patients >55 years old treated for hip fractures at our institution between October 2014 and January 2022 were analyzed for demographics, coronavirus disease 2019 (COVID-19) and vaccination status at admission, injury characteristics, hospital quality measures, and outcomes. Patients were divided into three separate cohorts: Pre-COVID-19 (PRECOV), COVID-19 Pre-Vaccine (PREVAX), and COVID-19 Post-Vaccine (POSTVAX). A sub-analysis removed COVID-19-positive patients across the study period. Comparative analyses were conducted. RESULTS A total of 2,633 hip fracture patients were included. For the overall cohort, there was no difference in the rate of inpatient deaths between the PRECOV, PREVAX, and POSTVAX cohorts (p=0.278). PRECOV had a significantly lower 30-day mortality rate compared to PREVAX or POSTVAX (p=0.012). Differences in complication rates for surgical site infection, urinary tract infection, and anemia (p<0.01 for all) were seen between cohorts. PRECOV had the longest length of hospital stay (p<0.01). PREVAX patients required more ICU level of care (p<0.01). When removing COVID-19-positive patients, all three cohorts had similar inpatient (p=0.872) and 30-day mortality rates (p=0.130). CONCLUSION The care of patients treated for hip fractures did not change throughout the pandemic at our institution. The elevated mortality rate due to the effects of COVID-19 seen in the pre-vaccine cohort decreased over time as the understanding of COVID-19 improved and the vaccine was introduced. We recommend continuation of the same hip fracture care protocols as used pre-pandemic.
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Affiliation(s)
- Sanjit R Konda
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Garrett W Esper
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Ariana T Meltzer-Bruhn
- Medical School, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Abhishek Ganta
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Kenneth A Egol
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
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Domingue G, Warren D, Koval KJ, Riehl JT. Complications of Hip Hemiarthroplasty. Orthopedics 2023; 46:e199-e209. [PMID: 36719411 DOI: 10.3928/01477447-20230125-06] [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] [Indexed: 02/01/2023]
Abstract
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [Orthopedics. 2023;46(4):e199-e209.].
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Vergouwen M, James MG, You DZ, White NJ. Trends in implementation of evidence-based hip fracture management in a major Canadian city. OTA Int 2023; 6:e274. [PMID: 37719312 PMCID: PMC10503671 DOI: 10.1097/oi9.0000000000000274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/05/2023] [Indexed: 09/19/2023]
Abstract
Aims The importance of hip fracture care has resulted in an abundance of hip fracture management literature. The degree this evidence is incorporated into clinical practice is unknown. We examined 5 trends in hip fracture management: arthroplasty versus fixation, total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented femoral stem fixation, short versus long cephalomedullary nail (CMN) fixation, and time from admission to surgery. Our primary aim was to understand and assess hip fracture management trends in relation to pertinent literature. Methods Data were collected from acute hip fractures in patients aged 50 years or older who presented from 2008 to 2018. ICD-10 diagnostic codes were assigned using preoperative radiographs. Surgical management was confirmed using intraoperative and postoperative radiographs and split into 6 categories: (1) short CMN, (2) long CMN, (3) cannulated screws, (4) dynamic hip screw, (5) HA, and (6) THA. Appropriate statistical tests were used to analyze trends. Results In 4 assessed trends, hip fracture management aligned with high-level evidence. This was the case for a trend toward arthroplasty for displaced femoral neck fractures, increased use of THA relative to HA, increased use of short relative to long CMNs, and consistent decrease in surgical wait times. Despite the literature highlighting the disadvantages of uncemented femoral stems, our data demonstrated increased use of uncemented femoral stems. Conclusion Evidence to guide orthopaedic practice is constantly emerging but may not be effectively used by clinicians. Our findings demonstrate the successes and failures of integrating evidence into hip fracture management and highlight that orthopaedic surgeons have an ongoing responsibility to strive for evidence-based practice.
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Affiliation(s)
- Martina Vergouwen
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
| | - Michael G. James
- Section of Orthopaedics, University of Pittsburgh, Pittsburgh, PA
| | - Daniel Z. You
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
| | - Neil J. White
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
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Mukherjee K, Ghorai TK, Kumar A. High grade femoral stem subsidence in uncemented hip hemiarthroplasty - A radiographic analysis and an early prediction while treating femoral neck fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:1591-1599. [PMID: 36988709 DOI: 10.1007/s00264-023-05791-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Femoral component subsidence is a known risk factor affecting almost all hip replacements using a collarless, cement-less stems. High grade subsidence >5mm is functionally limiting to the patient. Early analysis and prediction of this complication on the immediate post-operative radiographs will help surgeons to opt for alternative solutions to mitigate this complication. METHODS A retrospective study including 116 patients, who underwent cement-less bipolar hemi-arthroplasties treated from 2020-2022 were included in the study. Body Mass Index (BMI) and pre-operative American Society Anesthesiologist (ASA) score was retrieved from the medical records. Post operative radiographs on postoperative day two, at four weeks and at eight weeks were evaluated. Dorr's score, initial subsidence ratio (ISR) , stem angulation, proximal stem-canal fit (PSCF) ratio, distal stem-canal fit (DSCF) ratio, medial flare modifier (MFM) were recorded. RESULTS A total of 18 patients showed subsidence over 5mm on radiographs evaluated at four weeks. The mean high-grade stem subsidence was 13.5mm +/- 2.67. Evaluating their respective postoperative day two radiographs- ISR was >1 in 16 out of 18 patients (89%), PSCF ratio <0.75 in 83% and DSCF ratio <0.5 in 78% patients. All these patients had a neutral/negative MFM. BMI >25 (p<0.05) and ASA >3 (p<0.001) correlated with a higher degree of stem subsidence. CONCLUSION A lower BMI and ASA score accompanied by a positive MFM were protective factors against femoral stem subsidence. A higher ISR along with a PSCF ratio <0.75 and DSCF ratio <0.5, were highly predictive of stem subsidence over 5 mm.
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Affiliation(s)
- Kaustav Mukherjee
- Department of Orthopaedics, College of Medicine & JNM Hospital, Kalyani, West Bengal, India.
| | - Tushar Kanti Ghorai
- Department of Orthopaedics, College of Medicine & JNM Hospital, Kalyani, West Bengal, India
| | - Ajay Kumar
- Department of Orthopaedics, College of Medicine & JNM Hospital, Kalyani, West Bengal, India
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He Y, Tang X, Liao Y, Liu S, Li L, Li P. The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with Femoral Neck Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop Surg 2023. [PMID: 37154088 DOI: 10.1111/os.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. OBJECTIVE We performed an updated systematic review and meta-analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures. METHODS A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta-analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI). RESULTS Twenty-four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0-17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6-5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4-11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3-5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39-0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16-0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11-0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40-0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23-0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71-10.02; P < 0.001). CONCLUSION This meta-analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.
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Affiliation(s)
- Yue He
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiumei Tang
- Institute of Hospital Management West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liao
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shihua Liu
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingli Li
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengcheng Li
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Springer B, Hubble M, Howell J, Moskal JT. Cemented Femoral Stem Fixation: Back to the Future. J Arthroplasty 2023:S0883-5403(23)00369-8. [PMID: 37086929 DOI: 10.1016/j.arth.2023.04.023] [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: 11/28/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Periprosthetic fractures following elective and non-elective hip arthroplasty remain one of the most common modes of early failure. METHODS This symposium will explore the current role of cemented fixation and periprosthetic fracture, focusing on history and rationale for cemented stem fixation, registry data and other potential advantages of cemented stem fixation. A meticulous and methodical surgical technique of cemented stem fixation is paramount to the success and will be thoroughly discussed. RESULTS The role of stem fixation, and its effect on periprosthetic fracture is well-documented in the literature. Yet despite this, the utilization of cemented stem fixation remains low in the United States. This paradox is multifactorial. CONCLUSIONS In addition to a notable reduction in the risk of periprosthetic femur fractures, cemented stem fixation has numerous other advantages and is reproducible with a methodical surgical technique.
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Affiliation(s)
- Bryan Springer
- OrthoCarolina Hip and Knee Center and Atrium Musculoskeletal Institute , 2001 Vail Ave, Charlotte, NC, 28207
| | - Matthew Hubble
- Consultant Orthopaedic Surgeon, Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter. EX2 5DW
| | - Jonathan Howell
- Consultant Orthopaedic Surgeon, Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter. EX2 5DW
| | - Joseph T Moskal
- Professor and Chair, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, 2331 Franklin Rd, SW, Roanoke, VA, 24014
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Cohen JS, Agarwal AR, Kinnard MJ, Thakkar SC, Golladay GJ. The Association of Postoperative Osteoporosis Therapy With Periprosthetic Fracture Risk in Patients Undergoing Arthroplasty for Femoral Neck Fractures. J Arthroplasty 2023; 38:726-731. [PMID: 36328102 DOI: 10.1016/j.arth.2022.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Displaced femoral neck fractures in older adults are generally treated with hip arthroplasty. One concern following hip arthroplasty is the risk for periprosthetic fractures (PPFs). Most patients who have hip fractures are candidates for antiosteoporotic therapy, but the impact of this treatment on PPFs is unknown. Therefore, the primary objective of this study was to evaluate whether patients treated with antiosteoporotic medical therapy had lower odds of PPFs following arthroplasty for hip fracture. METHODS Patients at least 65 years old who underwent hip arthroplasty for femoral neck fractures from 2010 to 2020 were identified in a national database. Patients were stratified based on whether they initiated antiosteoporotic therapy within 1 year of hip arthroplasty. Minimum follow-up was 1 year, and maximum follow-up was 10.6 years. The primary endpoint was cumulative incidence of PPF as determined using Kaplan-Meier and Cox proportional hazards regression analyses. Overall, 2,026 patients who underwent arthroplasty for femoral neck fracture received antiosteoporotic medications within 1 year following surgery (mean follow up 4.8 years; range 1.0 to 10.6 years) and 33,639 patients did not (mean follow up 4.1 years; range 1.1 to 10.3 years). RESULTS The 10-year cumulative incidence of PPF for patients treated for osteoporosis was 3.88% compared to 5.92% for those who were untreated (P < .001). Adjusting for covariates, patients who received osteoporosis treatment had a significantly lower risk for PPF than those who were untreated (hazard ratio (HR): 0.663; 95% confidence interval (CI): 0.465-0.861; P = .038). CONCLUSION The present study suggests that osteoporosis treatment is associated with lower incidence of PPF following hip arthroplasty for femoral neck fractures. Treatment of osteoporosis should be initiated in eligible patients who sustain a femoral neck fracture, especially those who undergo hip arthroplasty.
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Affiliation(s)
- Jordan S Cohen
- University of Pennsylvania, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | - Amil R Agarwal
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matthew J Kinnard
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland
| | - Savyasachi C Thakkar
- Johns Hopkins University, Department of Orthopaedic Surgery, Baltimore, Maryland
| | - Gregory J Golladay
- Virginia Commonwealth University, Department of Orthopaedic Surgery, Richmond, Virginia
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Ramsay N, Close JCT, Harris IA, Harvey LA. The impact of cement fixation on early mortality in arthroplasty for hip fracture. Bone Jt Open 2023; 4:198-204. [PMID: 37051818 PMCID: PMC10032234 DOI: 10.1302/2633-1462.43.bjo-2023-0006.r1] [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: 04/14/2023] Open
Abstract
Cementing in arthroplasty for hip fracture is associated with improved postoperative function, but may have an increased risk of early mortality compared to uncemented fixation. Quantifying this mortality risk is important in providing safe patient care. This study investigated the association between cement use in arthroplasty and mortality at 30 days and one year in patients aged 50 years and over with hip fracture. This retrospective cohort study used linked data from the Australian Hip Fracture Registry and the National Death Index. Descriptive analysis and Kaplan-Meier survival curves tested the unadjusted association of mortality between cemented and uncemented procedures. Multilevel logistic regression, adjusted for covariates, tested the association between cement use and 30-day mortality following arthroplasty. Given the known institutional variation in preference for cemented fixation, an instrumental variable analysis was also performed to minimize the effect of unknown confounders. Adjusted Cox modelling analyzed the association between cement use and mortality at 30 days and one year following surgery. The 30-day mortality was 6.9% for cemented and 4.9% for uncemented groups (p = 0.003). Cement use was significantly associated with 30-day mortality in the Kaplan-Meier survival curve (p = 0.003). After adjusting for covariates, no significant association between cement use and 30-day mortality was shown in the adjusted multilevel logistic regression (odd rati0 (OR) 1.1, 95% confidence interval (CI) 0.9 to 1.5; p = 0.366), or in the instrumental variable analysis (OR 1.0, 95% CI 0.9 to 1.0, p=0.524). There was no significant between-group difference in mortality within 30days (hazard ratio (HR) 0.9, 95% CI 0.7to 1.1; p = 0.355) or one year (HR 0.9 95% CI 0.8 to 1.1; p = 0.328) in the Cox modelling. No statistically significant difference in patient mortality with cement use in arthroplasty was demonstrated in this population, once adjusted for covariates. This study concludes that cementing in arthroplasty for hip fracture is a safe means of surgical fixation.
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Affiliation(s)
- Niamh Ramsay
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Ian A Harris
- School of Clinical Medicine, University of New South Wales Sydney Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lara A Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
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Jäger M, Portegys E, Busch A, Wegner A. [Femoral neck fractures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:332-346. [PMID: 36867225 DOI: 10.1007/s00132-023-04364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
Femoral neck fractures (FNF) are the most frequent fractures in the older population and are also of high socioeconomic importance due to the high risk of mortality. The diagnostics are based on the clinical examination and imaging procedures. The classification systems used in the routine clinical practice are oriented towards the prognosis and are therefore a valuable aid in making decisions for the selection of the treatment procedure. Early surgery is decisive for the success of treatment. Older patients (> 60 years) with arthritically damaged hips and a high degree of fracture dislocation benefit from prompt hip replacement (bipolar systems, total hip arthroplasty, dual mobility systems). In contrast, joint-preserving surgery by osteosynthesis is indicated in younger patients with a low degree of dislocation. This article summarizes the clinically relevant aspects of FNF and gives an overview of current treatment strategies with inclusion of the scientific literature.
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Affiliation(s)
- M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland.
| | - E Portegys
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
| | - A Busch
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland
| | - A Wegner
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
- Klinik für Unfallchirurgie, Orthopädie, Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland
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Fu M, Shen J, Ren Z, Lv Y, Wang J, Jiang W. A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old. Front Med (Lausanne) 2023; 10:1085485. [PMID: 36817792 PMCID: PMC9932906 DOI: 10.3389/fmed.2023.1085485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Currently, whether bone cement can be applied in bipolar hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. The aim of this systematic review and meta-analysis was to compare the effectiveness and safety of cemented bipolar hemiarthroplasty (CBH) versus uncemented bipolar hemiarthroplasty (UCBH) in the treatment of FNFs among elderly patients over 60 years old. Materials and methods The Pubmed, Web of science, Cochrane Library and EMBASE databases were searched comprehensively for relevant articles from their inception to May 2022. Studies about comparing outcomes between CBH and UCBH for FNFs in elderly patients aged more than 60 years were included. Outcomes including operation time, intra-operative blood loss, length of hospital stay, wound infections, residual pain, revisions, re-operations, complications related to prosthesis, general complications, and mortality. The Review Manager 5.3 software provided by the Cochrane Collaboration Network was used to perform the meta-analysis of comparable data. Results A total of 6 randomized controlled trials (RCTs) and 9 observational studies were included in this analysis, with 33,118 patients (33,127 hips). Results of the meta-analysis indicated that the operation time [WMD = 13.01 min, 95% CI (10.79, 15.23)], intra-operative blood loss [WMD = 80.57 ml, 95% CI (61.14, 99.99)], incidence of heterotrophic ossification [OR = 2.07, 95% CI (1,14, 3.78)], were increased in the CBH group but the incidence of intra-operative fractures [OR = 0.24, 95% CI (0.07, 0.86)], periprosthetic fractures [OR = 0.24, 95% CI (0.18, 0.31)], aseptic loosening of prosthesis [OR = 0.20, 95% CI (0.09, 0.44)], wound infections [OR = 0.80, 95% CI (0.68, 0.95)] and re-operation rates [OR = 0.61, 95% CI (0.54, 0.68)] were lower in the CBH group by comparison with the UCHB group. However, there were no significant differences in residual pain, length of hospital stay, prosthetic dislocation, prosthetic subsidence (> 5 mm), acetabulum erosion, revisions, pulmonary infections, pulmonary embolisms, urinary tract infections, deep venous thromboses, decubitus, cardiovascular accidents (arrhythmia/myocardial infarction), and respiratory failure between the two groups. In terms of mortality, perioperative mortality (within 72 h) [OR = 2.39, 95% CI (1.71, 3.32)] and 1-week mortality postoperatively [OR = 1.22, 95% CI (1.05, 1.41)] in CBH group were higher than those in UCBH group, but there were no significant differences in mortality at 1 month, 3 months, 1 year, and 2 years postoperatively between CBH group and UCBH group. Conclusion This meta-analysis found that elderly patients over 60 years old with FNFs who underwent CBH had longer operation time, higher incidence of heterotrophic ossification, intra-operative blood loss, and mortality within 72 h of operation and at 1-week postoperatively, but lower incidence of periprosthetic fractures, aseptic loosening of prosthesis, intra-operative fractures, wound infections and re-operations. Other outcomes were not significantly different between the two groups. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021274253.
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Affiliation(s)
- Mengyu Fu
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Jieliang Shen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhoukui Ren
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Yingwen Lv
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Jiangang Wang
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China,*Correspondence: Jiangang Wang,
| | - Wei Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Wei Jiang,
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Wang J, Deng Z, Huang B, Zhao Z, Wan H, Ding H. The short-term outcomes of cementless stem for hip arthroplasty in the elderly patients: comparison with patients < 65 years. BMC Musculoskelet Disord 2022; 23:1070. [PMID: 36476470 PMCID: PMC9727981 DOI: 10.1186/s12891-022-06025-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The use of cement or cementless femoral stem prosthesis for hip arthroplasty in elderly patients has been controversial. This study investigated the efficacy and safety of cementless femoral stem in elderly patients (age ≥ 65 years). METHODS The short-term efficacy of primary hip arthroplasty with cementless femoral stem in our hospital from January 2014 to June 2021 was retrospectively analyzed. Patients were divided into two groups according to age: young group (< 65 years) and the elder group (≥ 65 years). The evaluation index was the Harris Hip score (Harris), postoperative femoral stem prosthesis sinking distance and femoral plant-related complications (periprosthetic fracture, prosthesis loosening, infection, dislocation, etc.). RESULTS There were 72 cases of 86 hips in the young group and 83 cases of 92 hips in the elder group. The recovery trend of functional score in the elder group was similar to that in the young group, and the Harris score increased from (38.35 ± 18.21) before surgery to (86.91 ± 12.55) at last follow-up (p < 0.01). Compared with the two groups at the same time of 3 months, 6 months and 12 months after operation, the sinking distance of the elder group was significantly greater (P < 0.05). Even in the elder group, there was a significant difference in sinking distance between 6 and 3 months after surgery (2.44 ± 0.49 mm vs 2.10 ± 0.65 mm, P = 0.004). However, there was no significant difference between 12 and 6 months (2.53 ± 0.53 mm vs 2.44 ± 0.49 mm, P = 0.40). A total of 10 patients in the elder group and 6 patients in the young group had a complication event (P = 0.36). CONCLUSIONS Elderly patients with cementless femoral stems can achieve metal-bone integration slightly longer than young patients, but short-term clinical outcomes can be restored to a satisfactory level with adequate safety. However, the long-term efficacy still needs to be verified by multicenter, large sample size and prospective clinical follow-up results.
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Affiliation(s)
- Jun Wang
- grid.440187.eDepartment of Orthopaedic Surgery, the First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, 400010 China
| | - Zhibo Deng
- grid.415108.90000 0004 1757 9178Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, 350001 Fuzhou, China
| | - Bin Huang
- grid.440187.eDepartment of Orthopaedic Surgery, the First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, 400010 China
| | - ZhengMing Zhao
- grid.440187.eDepartment of Orthopaedic Surgery, the First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, 400010 China
| | - HaiMing Wan
- grid.440187.eDepartment of Orthopaedic Surgery, the First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, 400010 China
| | - Hong Ding
- grid.440187.eDepartment of Orthopaedic Surgery, the First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, 400010 China
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Dahl OE, Pripp AH. Response to the Letter to the Editor: Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated With Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:2470-2471. [PMID: 36332005 PMCID: PMC10538910 DOI: 10.1097/corr.0000000000002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Dislocation rate, revisions and other complications of primary cemented hemiarthroplasty for displaced femoral neck fractures: a single-center cohort study of 743 unselected hips with a mean 2.7-year follow-up. Arch Orthop Trauma Surg 2022; 142:3797-3802. [PMID: 34779885 DOI: 10.1007/s00402-021-04252-w] [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: 06/10/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Evidence of whether to use hemiarthroplasty (HA) or total hip arthroplasty for displaced femoral neck fractures (FNF) is still widely debated, especially when taking ambulatory status, age, and patient cognitive status into account. The current study aims to report the rates of dislocations, revisions and other complications for primary cemented HA in patients with displaced FNF. MATERIALS AND METHODS Single-center retrospective follow-up study of an unselected historic cohort. 743 consecutive hips (551 W and 192 M) at mean (SD) age of 83.6 (8.4) years received primary cemented HA for displaced FNF by posterolateral surgical approach between January 2012 and December 2019. Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death or end of the follow-up period, and the educational level of the surgeon was noted. RESULTS During a mean (SD) follow-up period of 2.7 (2.2) years, there were 6.1% (n = 45) dislocations, in which 82% (first dislocation) appeared within the first 30 postoperative days, and 51% (n = 23) of the dislocations requiring subsequent surgery. At the time of the last available follow-up, 57% (n = 421) of the patients were dead. A non-dislocation related revision was needed in 3.4% (n = 25) of the patients [in which infection accounted for 40% (n = 10) and traumatic periprosthetic fracture for 32% (n = 8)]. Thirty-day mortality was 9.2% and 1-year mortality 25.8%. There were no differences in patient's age, gender, or educational level of the surgeon between the dislocation and the no dislocation groups. Patients aged < 70 years presented with a higher dislocation rate (p < 0.001) than the patients aged > 70 years. CONCLUSION Primary HA presents a safe and robust approach with acceptable complication rates in a genuine unselected cohort of displaced FNF, particularly for patients aged > 70.
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Shi P, Li N, Zhou S, Hua K. Letter to the Editor: Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated With Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:2468-2469. [PMID: 36374582 PMCID: PMC10538899 DOI: 10.1097/corr.0000000000002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Pengfei Shi
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
| | - Na Li
- Department of Anesthesiology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
| | - Shenghu Zhou
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
| | - Kangle Hua
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
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Bökeler U, Bühler A, Eschbach D, Ilies C, Liener U, Knauf T. The Influence of a Modified 3rd Generation Cementation Technique and Vaccum Mixing of Bone Cement on the Bone Cement Implantation Syndrome (BCIS) in Geriatric Patients with Cemented Hemiarthroplasty for Femoral Neck Fractures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1587. [PMID: 36363544 PMCID: PMC9696240 DOI: 10.3390/medicina58111587] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 10/14/2023]
Abstract
Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality.
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Affiliation(s)
- Ulf Bökeler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Alissa Bühler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
| | - Christoph Ilies
- Department for Anesthesia and Intensive Care, Marienhospital Stuttgart, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
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Comparing Outcomes in Cemented and Press-Fit Hemiarthroplasty. J Am Acad Orthop Surg 2022; 30:979-983. [PMID: 35551159 DOI: 10.5435/jaaos-d-21-01178] [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] [Received: 12/06/2021] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroplasty has become the standard of care for displaced femoral neck fractures in the geriatric cohort. However, details regarding optimal implant design and fixation strategy continue to be debated. We sought to determine whether cemented or press-fit hemiarthroplasties were more advantageous in terms of revision surgery, contralateral hip fractures, hospital length of stay, mortality rates, and survival. METHODS All geriatric fragility hip fractures at a level 1 trauma center (2014 to 2019) were retrospectively reviewed for the fracture pattern, fixation methodology, and outcome, yielding 707 femoral neck fractures treated with hemiarthroplasty (309 cemented and 398 press fit). The final follow-up was either date of death or final encounter. Major end points were revision surgery, contralateral fracture, and death. A Z-score test of two proportions was used for dichotomous variables, and a two-tailed t -test was used for continuous variables. Cox proportional hazard was used for revision surgery-free survival between groups, adjusting for age, sex, and American Society of Anesthesiologists status. RESULTS Patients who underwent press-fit hemiarthroplasty had a significantly higher rate of revision surgery (7.8% vs 3.9%; P = 0.006). Press-fit cases had a trend toward a decreased risk of contralateral fracture (13% vs 9.8%; P = 0.12), although this did not reach significance. Both groups had similar length of stay ( P = 0.08) and death rates ( P = 0.39). Of those who died, there was a trend toward longer survival in patients who received a press-fit hemiarthroplasty (413 vs 615 days; P < 0.001). There was a trend toward longer survival without repeat surgery in the cemented group without reaching significance (hazard ratio, 0.66 [0.34 to 1.23]; P = 0.201). CONCLUSION In this study, we found a markedly longer survival time after press-fit hemiarthroplasty, which we believe reflects surgeons' tendencies to cement the femoral prosthesis in patients with more comorbidities. However, press-fit hemiarthroplasties were more likely to result in repeat procedures on the same hip. Displaced geriatric femoral neck fractures may benefit from a cemented rather than press-fit hemiarthroplasty.
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Hoskins W, Corfield S, Lorimer M, Peng Y, Bingham R, Graves SE, Vince KG. Is the Revision Rate for Femoral Neck Fracture Lower for Total Hip Arthroplasty Than for Hemiarthroplasty?: A Comparison of Registry Data for Contemporary Surgical Options. J Bone Joint Surg Am 2022; 104:1530-1541. [PMID: 35920553 DOI: 10.2106/jbjs.21.01256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When arthroplasty is indicated for a femoral neck fracture (FNF), it is unclear whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is best. This study compares data from the Australian Orthopaedic Association National Joint Replacement Registry using contemporary surgical options. METHODS Patients from 60 to 85 years old who were treated with arthroplasty for FNF, between September 1999 and December 2019, were included if the femoral stems were cemented. Only THAs with femoral heads of ≥36 mm or dual-mobility articulations were included. Patients who had monoblock HA were excluded. Rates of revision for all aseptic failures and dislocation were compared. Competing risks of revision and death were considered using the cumulative incidence function. Subdistribution hazard ratios (HRs) for revision or death from a Fine-Gray regression model were used to compare THA and HA. Interactions of procedure with age group and sex were considered. Secondary analysis adjusting for body mass index (BMI) and American Society of Anesthesiologists (ASA) classification was also considered. RESULTS There were 4,551 THA and 29,714 HA procedures included. The rate of revision for THA was lower for women from 60 to 69 years old (HR = 0.58 [95% confidence interval (CI), 0.39 to 0.85]) and from 70 to 74 years old (HR = 0.65 [95% CI, 0.43 to 0.98]) compared with HA. However, women from 80 to 85 years old (HR = 1.56 [95% CI, 1.03 to 2.35]) and men from 75 to 79 years old (HR = 1.61 [95% CI, 1.05 to 2.46]) and 80 to 85 years old (HR = 2.73 [95% CI, 1.89 to 3.95]) had an increased rate of revision when THA was undertaken compared with HA. There was no difference in the rate of revision for dislocation between THA and HA for either sex or age categories. CONCLUSIONS When contemporary surgical options for FNF are used, there is a benefit with respect to revision outcomes for THA in women who are <75 years old and a benefit for HA in women who are ≥80 years old and men who are ≥75 years old. There is no difference in dislocation rates. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand
| | - Sophia Corfield
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Roger Bingham
- Traumaplasty Melbourne, Melbourne, Victoria, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Kelly G Vince
- Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand
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Stratos I, Eidmann A, Eisert M, Horas K, Rudert M. The Endoprosthetic Treatment of Femoral Neck Fractures in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:564-565. [PMID: 36422872 PMCID: PMC9743214 DOI: 10.3238/arztebl.m2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/16/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Ioannis Stratos
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Annette Eidmann
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Marius Eisert
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Konstantin Horas
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Maximilian Rudert
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
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EK S, AL-ANI H, GREVE K, MODIG K, HEDSTRÖM M. Internal fixation or hip replacement for undisplaced femoral neck fractures? Pre-fracture health differences reflect survival and functional outcome. Acta Orthop 2022; 93:643-651. [PMID: 35819453 PMCID: PMC9275487 DOI: 10.2340/17453674.2022.3974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Internal fixation (IF) has been the standard procedure for undisplaced femoral neck fractures (FNFs). However, there is a changing trend towards hip replacement (HR). Yet there is a knowledge gap regarding the benefits of this surgical method. We investigated functional outcomes in patients ≥ 70 years following HR compared to IF for undisplaced FNFs. PATIENTS AND METHODS Patients ≥ 70 years with undisplaced FNF registered in the Swedish National Hip Fracture Registry (SHR) who underwent either IF or HR (hemiarthroplasty [HA)] or total hip arthroplasty [THA]) were investigated in terms of 1-year survival and proportion of reoperation. In a subsample with 4-month follow-up data (n = 3,623), pain, changes in living status, and physical function were additionally analyzed. RESULTS 7,758 patients were included with a mean age of 85 years. 93% of the patients were operated on with IF, 5% with HA, and 2% with THA. Patients with THA more often lived independently and were able to walk outdoors, both before and after the hip fracture. The IF and HA groups were similar in baseline characteristics, and in functional and survival outcomes. The THA group had a 54% lower adjusted risk of 1-year mortality. The proportion of reoperations within 1 year was 9.5% for IF, 5.3% for HA, and 7% for THA. INTERPRETATION The pre-fracture difference in health and function between patients operated on with IF, HA, and THA maked it difficult to compare outcomes of the 2 methods. Decision on surgical method must be taken on an individual level, considering patients' well-being and allocation of resources.
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Affiliation(s)
- Stina EK
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm
| | - Helen AL-ANI
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
| | - Katarina GREVE
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm
| | - Karin MODIG
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm
| | - Margareta HEDSTRÖM
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm,Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
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Wongsak S, Sa-Ngasoongsong P, Pinitkwamdee S, Thongchuea N, Prasai AB, Warinsiriruk E, Jarungvittayakon C, Jaovisidha S, Chanplakorn P. Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system. Injury 2022; 53:2454-2461. [PMID: 35660012 DOI: 10.1016/j.injury.2022.05.034] [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: 11/12/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic femoral fracture (PFF) is well-known complication in cementless hip arthroplasty (HA), especially in the elderly with osteoporosis. To prevent intraoperative PFFs during HA, prophylactic cerclage wiring on the calcar area during femoral broaching and implant insertion is recommended. However, biomechanical data on the benefits of cerclage wiring in osteoporotic bone during impaction are limited and controversial. This study aimed to assess the efficacy of prophylactic double-looped cerclage wiring (PDLCW) during femoral broaching in the osteoporotic bone model with an impaction simulation system. METHODS Fifteen osteoporotic femur models were prepared and allocated to three groups; control group (no cerclage), PW group (received PDLCW), and CC+PW group (prepared as having calcar crack and received PDLCW). All femurs were broached under impaction force that sequentially increased until the visible fracture or calcar crack propagation was visible. The primary outcomes were mallet impaction force (MIF-CF) and mallet velocity (MV-CF) at the time of calcar fracture. The secondary outcomes were calcar fracture pattern and subsidence during calcar fracture (S-CF). RESULTS PW group showed a significant increase in average MIF-CF, by 40.4% and 120.2% (p<0.001) compared to the control and CC+PW groups, respectively. The average MV-CF in PW group was also significantly greater, 13.1% and 64.6% (p<0.001), compared to the control and CC+PW groups, respectively. Control group revealed significantly greater incidence of complete calcar fracture (60% vs. 0% vs. 0%, p = 0.024), and the highest S-CF compared to those in the PW and CC+PW groups (10.6 ± 6.0 mm, 6.7 ± 4.4 mm, and 1.3 ± 2.0 mm, p = 0.020). CONCLUSIONS This study showed that PDLCW significantly improved hoop stress resistance by increasing the calcar fracture threshold related to mallet impaction, decreasing the risk of complete calcar fracture.
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Affiliation(s)
- Siwadol Wongsak
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Siwadol Pinitkwamdee
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Nutchanat Thongchuea
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Abigyat Babu Prasai
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand
| | - Eakkachai Warinsiriruk
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Chavarat Jarungvittayakon
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
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Khanuja HS, Mekkawy KL, MacMahon A, McDaniel CM, Allen DA, Moskal JT. Revisiting Cemented Femoral Fixation in Hip Arthroplasty. J Bone Joint Surg Am 2022; 104:1024-1033. [PMID: 35298444 PMCID: PMC9969348 DOI: 10.2106/jbjs.21.00853] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ➤ Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ➤ Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ➤ The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality. ➤ We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.
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Affiliation(s)
- Harpal S. Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kevin L. Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Donald A. Allen
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| | - Joseph T. Moskal
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
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Narkbunnam R, Kongwachirapaitoon P, Ruangsomboon P, Chareancholvanich K, Pornrattanamaneewong C. Reoperation rate and implant survivorship compared between cementless and cemented bipolar hemiarthroplasty in femoral neck fracture patients with chronic kidney disease. Injury 2022; 53:1114-1121. [PMID: 34823847 DOI: 10.1016/j.injury.2021.11.010] [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: 08/11/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is commonly associated with aging and disorders of mineral and bone metabolism. Femoral neck fracture (FNF) is one of the most common fractures among older adults with coexisting CKD, and bipolar hemiarthroplasty (BHA) is a preferred treatment. However, the optimal method of stem fixation has not been conclusively determined. Accordingly, this study aimed to investigate the reoperation rate and implant survivorship compared between cementless and cemented BHA in FNF patients with CKD. METHODS A total of 183 FNF patients with moderate to severe CKD who underwent BHA during 2003 to 2019 were recruited and divided into either the cemented (CT group, n = 56) or cementless (CL group, 127) groups. Demographic data, preoperative laboratory investigations, preoperative radiographic outcomes, perioperative outcomes, and 90-day morbidity, mortality, and reoperation rates for any reason were recorded and compared between groups. Kaplan-Meier survival analysis was used to compare implant survivorship between the CT and CL groups. Cox proportional hazards regression model was used to identify independent risk factors for implant survivorship. RESULTS There were no significant differences in patient characteristics or preoperative data between groups, except for Dorr's classification of proximal femoral geometry. The CT group had a significantly lower proportion of Dorr type A (p = 0.020), and a higher proportion of Dorr type C (p<0.001). The CT group also had significantly more intraoperative blood loss (p<0.01). No significant differences in morbidity or mortality were observed. The median follow-up time in the CT group and CL group was 22.6 months (range: 0-151) and 22.6 months (range 0-154), respectively (p = 0.607). The reoperation rate was 5.4% and 4.7% among CT and CL patients, respectively (p = 1.000). There was no significant difference in the mean survival time between the CT (139.5 ± 6.3 months, 95%CI: 127.1-151.8) and CL (142.5 ± 4.7 months, 95%CI: 133.2-151.7) groups (p = 0.880). Univariate and multivariate analyses revealed no independent risk factors for implant survivorship. CONCLUSION The results of this study showed no significant differences in the reoperation rate or implant survivorship between cemented and cementless BHA for treating FNF in moderate to severe CKD patients. A well-designed larger and longer-term study is needed to confirm these results.
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Affiliation(s)
- Rapeepat Narkbunnam
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pipat Kongwachirapaitoon
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pakpoom Ruangsomboon
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Keerati Chareancholvanich
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Chaturong Pornrattanamaneewong
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Rogmark C. How to Fill the Void - Bone Cement in Hemiarthroplasty. N Engl J Med 2022; 386:594-595. [PMID: 35139278 DOI: 10.1056/nejme2119282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Cecilia Rogmark
- From the Department of Orthopedics, Skåne University Hospital, Lund University, Malmö, Sweden
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Fernandez MA, Achten J, Parsons N, Griffin XL, Png ME, Gould J, McGibbon A, Costa ML. Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture. N Engl J Med 2022; 386:521-530. [PMID: 35139272 DOI: 10.1056/nejmoa2108337] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available. METHODS We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075). RESULTS A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups. CONCLUSIONS Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).
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Affiliation(s)
- Miguel A Fernandez
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Juul Achten
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Nicholas Parsons
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Xavier L Griffin
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - May-Ee Png
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Jenny Gould
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Alwin McGibbon
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Matthew L Costa
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
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Viberg B, Pedersen AB, Kjærsgaard A, Lauritsen J, Overgaard S. Risk of mortality and reoperation in hip fracture patients undergoing cemented versus uncemented hemiarthroplasty : a population-based study from Danish National Registries. Bone Joint J 2022; 104-B:127-133. [PMID: 34969285 DOI: 10.1302/0301-620x.104b1.bjj-2021-0523.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the association of mortality and reoperation when comparing cemented and uncemented hemiarthroplasty (HA) in hip fracture patients aged over 65 years. METHODS This was a population-based cohort study on hip fracture patients using prospectively gathered data from several national registries in Denmark from 2004 to 2015 with up to five years follow-up. The primary outcome was mortality and the secondary outcome was reoperation. Hazard ratios (HRs) for mortality and subdistributional hazard ratios (sHRs) for reoperations are shown with 95% confidence intervals (CIs). RESULTS A total of 17,671 patients with primary HA were identified (9,484 uncemented and 8,187 cemented HAs). Compared to uncemented HA, surgery with cemented HA was associated with an absolute risk difference of 0.4% for mortality within the period zero to one day after surgery and an adjusted HR of 1.70 (95% CI 1.22 to 2.38). After seven days, there was no longer any association, with an adjusted HR of 1.07 (95% CI 0.90 to 1.28). This continued until five years after surgery with a HR of 1.01 (95% CI 0.96 to 1.06). There was a higher proportion of reoperations due to any reason after five years in the uncemented group with 10.2% compared to the cemented group with 6.1%. This yielded an adjusted sHR of 0.65 (95% CI 0.57 to 0.75) and difference continued up until five years after the surgery, demonstrating a sHR of 0.70 (95% CI 0.59 to 0.83). CONCLUSION In a non-selected cohort of hip fracture patients, surgery with cemented HA was associated with a higher relative mortality during the first postoperative day compared to surgery with uncemented HA, but there was no difference after seven days up until five years after. In contrast, surgery with cemented HA was associated with lower risk of reoperation up to five years postoperatively compared with surgery with uncemented HA. There was a higher relative mortality on the first postoperative day for cemented HA versus uncemented HA. There was no difference in mortality after seven days up until five years after surgery. There were 6.1% reoperations for cemented HA compared to 10.2% for uncemented HA after five years. Cite this article: Bone Joint J 2022;104-B(1):127-133.
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Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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50
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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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