Abstract
Introduction
National Institute for Health and Clinical Excellence (NICE) guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractured neck of femur (NOF) in cognitively intact patients who were independently mobile prior to the injury. The National Joint Registry for England and Wales (NJR) has collected data on THRs performed since 2003. This retrospective cohort study explores risk factors independently associated with implant failure and perioperative mortality.
Methods
NJR data recording a THR performed for acute fractured NOF between 2003 and 2010 were analysed. Cox proportional hazards models were used to analyse the extent to which risk of implant revision was related to specific covariates. Multivariable logistic regression was used to analyse factors affecting 90-day perioperative mortality. Significance was taken as p< 0.01.
Result
A total of 4495 procedures were analysed, of which 83 (1.9%) underwent revision surgery and 144 (3.2%) patients died within 90 days. Increased risk of implant revision was associated with the use of cementless prostheses (Hazard Ratio [HR]=2.23, p=0.001), but revision risk was independent of age, American Society of Anaesthesiologists (ASA) grade, gender, head size and head material. Risk of mortality within 90 days was significantly associated with high ASA (grade 3: Odds ratio [OR]=7.20, p< 0.001, grade 4/5: OR=38.09, p< 0.001, referenced to grade 1 group) and older age (≥81 years: OR=2.04, p=0.004, referenced to 60–70 years group). Mortality risk was lower in patients who had a hybrid THR (OR=0.51 p=0.004), after risk adjustment.
Conclusion
There is considerably greater risk of implant revision when cementless THR is used for managing fractured NOF. Risk of perioperative mortality is greatest in patients over 80 years with ASA grades 3 or above, and lowest with hybrid THR. This information may be used to guide the surgical management of patients with fractured neck of femur.
