Total Hip Arthroplasty For Femoral Neck Fracture (original) (raw)
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Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty
Geriatric orthopaedic surgery & rehabilitation, 2018
There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. To...
Archives of bone and joint surgery, 2014
Previous studies suggest total hip arthroplasty may have some benefits compared to hemi-arthroplasty for displaced intracapsular femoral neck fractures in patients more than 60 years of age. The primary research question of our study was whether in-hospital adverse events, post-operative length of stay (LOS) and mortality in patients 60 year of age or older differed between total hip and hemi-arthroplasty for femoral neck fracture. We obtained data on 82951 patients more than 60 years of age with an isolated femoral neck fracture treated with either hemi-arthroplasty or total hip arthroplasty in 2009 or 2010 from the National Hospital Discharge Survey (NHDS) database. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9, CM) was used to code diagnoses, comorbidities, complications, and procedures. Controlling for demographics and comorbidities, patients treated with hemi-arthroplasty had a 40% (95% CI 1.4-1.5) higher risk of adverse events compare...
Journal of Orthopedic and Spine Trauma, 2021
Background: Femoral neck fracture as a prevalent skeletal injury accounts for 7% of orthopedic hospital admission. The aim of the present study is to evaluate the functional outcome of patients with femoral neck fracture treated with total hip arthroplasty (THA) and compare them with those undergoing fixation treatment. Methods: In this study, we reviewed patients in the age range of 45-60 years old with femoral neck fracture during 2007-2017. The subjects were assigned to either THA or fixation group. The primary outcome was hip function, evaluated with the Harris Hip Scale (HHS). Secondary outcomes included pain, local infection, avascular necrosis (AVN), thromboembolic event, loosening of the prosthetic and internal fixation device, prosthetic dislocation, non-union, and delayed-union. Results: In this study, 34 patients with displaced fracture of femoral neck were treated with acute THA and 38 patients were treated with fixation. The HHS was higher in the THA group compared to t...
Hip Arthroplasty Done for Osteoarthritis vs. Hip Fractures: A Comparison
Acta Scientific Orthopaedics
Introduction: Osteoarthritis and femoral neck fractures are two important entities which are indications for hip arthroplasties and cause a significant burden to the healthcare system. It is imperative to compare the patient characteristics and operative complications in both these cohorts and whether existing NICE guidelines for patient selection is appropriate. Materials and Methods: 300 patients' data from a district general hospital in Surrey, United Kingdom was retrospectively studied and analyzed. Results: From our study, it was clear that women suffered more hip fractures than men. Average length of hospital stay was higher in the group that received Hip Hemi-arthroplasty compared to the patients who received a Total Hip Arthroplasty (12.7 ± 9 vs 8.2 ± 3.9 days). Institutionalized patients were more likely to have HHA compared to those living in their own homes (p-value < .05). Patients who were selected for HHA had higher mortality rates (53%) during our follow up period compared to those selected for THA. The post-operative dislocation rates were comparable and not statistically significant. Conclusion: Careful patient selection for the type of arthroplasty through existing NICE guidelines has proved beneficial for patients in terms of length of hospital stay and post-operative morbidity and mortality. There is still a need for clearer follow-up guidelines for patients suffering from a hip fracture, which needs to be worked up in detail.
The Journal of Arthroplasty, 2008
The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. Forty subjects were enrolled. At 24 months, THA patients had significantly less pain on the SF-36 subscale than hemiarthroplasty patients (54.8 ± 7.9 vs 44.7 ± 10.5, P = .04) and scored significantly better on the SF-36 mental health subscale (54.9 ± 9.4 vs 40.9 ± 10.3, P = .006). Total hip arthroplasty patients also had superior WOMAC function scores (81.8 ± 10.2 vs 65.1 ± 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.
Neck of femur fracture: who gets a total hip replacement? A review of 230 eligible patients
European Journal of Trauma and Emergency Surgery, 2020
Purpose To investigate patient-specific factors that predict Total Hip Replacement (THR) in patients with fracture neck of femur (NOF), fulfilling the National Institute of Health and Care Excellence (NICE) criteria. Methods Hip fracture database from a district general hospital and university hospital was retrospectively reviewed to identify patients fulfilling NICE criteria for THR after fracture NOF. Patient demographics, Nottingham Hip Fracture score (NHFS), complications, re-operations, revision, 30 days and one-year mortality was obtained from patient-records. Independent predictors correlating with the outcome of surgery were identified. A logistic regression analysis was used to predict the type of surgery in these patients. Results A total of 230 (114 WMH and 116 MH) were identified; 133 (57.8 percent) received hip hemiarthroplasty (HA), and 97 (42.2 percent) received THR. Patients receiving THR (mean 73.5 years, 95% CI 72-74.8) were significantly younger in comparison to patients receiving HA (mean 81.7 years, 95% CI 80.5-82.8). A negative correlation is noted between NHFS and type of surgery (Pearson's correlation − 0.537, p < 0.01), implying higher NHFS decreased the likelihood of receiving THR. Regression analysis showed NHFS (p-0.001) and walking ability (p-0.001) as significant predictors for the type of surgery (Nagelkerke R2-0.472). A log-rank test showed higher estimated survival time in patients with THR in comparison to HA (p-value 0.002). Conclusions NHFS and walking ability can be used as an adjunct to the NICE criteria for selecting patients for THR after fracture NOF. Carefully selected patients treated with THR survive longer and have a better outcome in comparison to HA. Keywords Hip fracture • Total hip replacement • Neck of femur fracture • Nottingham hip fracture score (NHFS)