Systematic reviews disagree, but some recent studies have shown better function and less pain after operation with bipolar hemiarthroplasty compared to fixation by two screws in elderly patients operated for displaced femoral neck fractures. There is still uncertainty regarding the mortality associated with both procedures. To investigate mortality and the risk factors for death among patients with displaced femoral neck fractures within the first three years after surgery, comparing operation with bipolar hemiarthroplasty (HA) and internal fixation (IF) by two screws.Background
Aim of the study
A well conducted randomised study found similar functional results for patients with displaced femoral neck fracture comparing operation with a modern uncemented bipolar hemiarthroplasty with a cemented bipolar hemiarthroplasty. The mortality associated with the two procedures has not been sufficiently investigated. To investigate the mortality and the risk factors for death among patients with displaced femoral neck fractures the first year after surgery, comparing operation with modern uncemented and cemented bipolar hemiarthroplasty (HA).Background
Aim of study
Bipolar hemiarthroplasty(BPHA) for displaced intracapsular neck of femur fractures(DICNOF) is a controversial topic as conflicting evidence exists. The most common reason for revision to total hip arthroplasty(THA) from BPHA is acetabular erosion. In our study, we sought to quantify the direction of migration of the bipolar head within the first 3 years post-operatively. A proportional index in the horizontal and vertical planes of the pelvis were used to quantify migration. This method removed the need to account for magnification and rotation of the radiographs.Abstract
Introduction
Methods
Recent NICE guidelines suggest that Total Hip Arthroplasty (THA) be offered to all patients with a displaced intracapsular neck of femur fracture who: are able to walk independently; not cognitively impaired and are medically fit for the anaesthesia and procedure. This is likely to have significant logistical implications for individual departments. Data from the National Hip Fracture Database was analysed retrospectively between January 2009 and November 2011. The aim was to determine if patients with displaced intracapsular neck of femur fractures admitted to a single tertiary referral orthopaedic trauma unit received a THA if they met NICE criteria. Case notes were then reviewed to obtain outcome and complication rates after surgery. Five hundred and forty-six patients were admitted with a displaced intracapsular neck of femur fracture over the described time period. Sixty-five patients met the NICE criteria to receive a THA (mean age 74 years, M:F = 16: 49); however, 21 patients had a THA. The other patients received either a cemented Thompson or bipolar hemiarthroplasty. Within the THA cohort there were no episodes of dislocation, venous thromboembolism, significant wound complications or infections that required further surgery. Within the hemiarthroplasty cohort there was 2 mortalities, 2 implant related infections, 1 dislocation and 2 required revision to a THA. There is evidence to suggest better outcomes in this cohort of patients, in terms pain and function. There is also a forecasted cost saving for departments, largely due to the relative reduction in complications. However, there were many cases (44) in our department, which would have been eligible for a THA, according to the NICE guidelines, who received a hemiarthroplasty. This is likely a reflection of the increased technical demand, and larger logistical difficulties faced by the department. We did note more complications within the hemiarthroplasty group, however, the numbers are too small to address statistical significance, and a longer follow up would be needed to further evaluate this. There is a clear scope for optimisation and improvement of infrastructure to develop time and resources to cope with the increased demand for THA for displaced intracapsular neck of femur fractures, in order to closely adhere to the NICE guidelines.
We sought to establish whether HEMI or THA gave better results in independent mobile patients with displaced femoral neck fracture.
After THA, three patients died, three dislocated, one required revision. Mean walking distance was 2.23 miles and OHS was 18.8. There was no radiological evidence of polyethylene wear Patients with THAs after three years walked further (p=0.039) and had a lower OHS (p=0.033).
THA is a preferable option to HEMI in independent mobile elderly patients with displaced intracapsular femoral neck fracture.
Arthroplasty is the most effective management of displaced intracapsular femoral neck fracture. Hemiarthroplasty (HEMI) is associated with acetabular erosion and loosening in mobile patients and total hip arthroplasty (THA) with instability. We sought to establish whether HEMI or THA gave better results in independent mobile patients with displaced intracapsular femoral neck fracture. Eighty-two patients were randomised into two groups. One arm received a modular HEMI, the second a THA using the same femoral stem. Patients were followed for a mean of three years after surgery. After HEMI, eight patients died, two were revised to THA and there is intention to revise three. One patient had a periprosthetic fracture. Mean walking distance was 1.08 miles and Oxford Hip Score (OHS) 22.5. Twenty patients (64.5% of survivors) had radiological evidence of acetabular erosion. After THA, four patients died, three dislocated, one required revision. Mean walking distance was 2.23 miles and OHS was 18.8. HEMI is associated with a higher rate of revision than THA and potential revision because of acetabular erosion. THA after three years displayed superior walking distances (p=0.039) and lower OHS (p=0.033). THA is a preferable option to HEMI in independent mobile elderly patients with displaced intracapsular femoral neck fracture.
Over the past decade there has been a shift in the approach to management of many femoral neck fractures. As noted by Miller et al. those trends are reflected in the practice patterns of surgeons applying for board certification through the American Board of Orthopaedic Surgeons. From 1999 to 2011 there was a trend toward total hip arthroplasty and corresponding small decreases in the use of hemi-arthroplasty and internal fixation for treatment of femoral neck fractures. For many years the treatment approach has been a simple diagnosis-related algorithm predicated upon classification of the fracture as displaced (historically treated with hemi-arthroplasty) or non-displaced (historically treated with internal fixation). More recently, however, the focus has shifted to a patient-centered approach. In the patient-centered approach factors such as age, functional demands, pre-existent hip disease and bone quality should all be considered. In the contemporary setting it is still important to distinguish between displaced and non-displaced fracture patterns. Non-displaced femoral neck fractures, regardless of patient age or activity, are well-suited to closed reduction and internal fixation, most commonly with three cannulated screws. The union rate is high in non-displaced fractures treated with internal fixation and the benefits of preserving the native hip joint are substantial.
Introduction.
This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time. Overall, 37,708 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked with data in the Norwegian Patient Registry. Hospitals treating hip fractures were characterized according to their hip fracture care. Waiting time (hours from admission to start of surgery), surgery within regular working hours, and surgery on the day of or on the day after admission, i.e. ‘expedited surgery’ were estimated.Aims
Methods
Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel’s fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years.Aims
Methods
The June 2014 Hip &
Pelvis Roundup360 looks at: Modular femoral necks: early signs are not good; is corrosion to blame for modular neck failures; metal-on-metal is not quite a closed book; no excess failures in fixation of displaced femoral neck fractures; noise no problem in hip replacement; heterotopic ossification after hip arthroscopy: are NSAIDs the answer?; thrombotic and bleeding events surprisingly low in total joint replacement; and the elephant in the room: complications and surgical volume.