Aims

Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era.

Aims

The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients.

Background. Improving positioning and alignment by the use of computer assisted surgery (CAS) might improve longevity and function in total knee replacements. This study evaluates the short term results of computer navigated knee replacements based on data from a national register. Patients and Methods. Primary total knee replacements without patella resurfacing, reported to the Norwegian Arthroplasty Register during the years 2005–2008, were evaluated. The five most common implants and the three most common navigation systems were selected. Cemented, uncemented and hybrid knees were included. With the risk for revision due to any cause as the primary end-point, 1465 computer navigated knee replacements (CAS) were evaluated against 8214 conventionally operated knee replacements (CON). Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex, prosthesis brand, fixation method, previous knee surgery, preoperative diagnosis and ASA category were used. Results. Kaplan-Meier estimated survival at two years was 97.9% (95% CI: 97.5–98.3) in the CON group and 96.4% (95% CI: 95.0–97.8) in the CAS group. The adjusted Cox regression analysis showed a statistically significantly higher risk for revision in the CAS group (relative risk = 1.7, 95% CI: 1.1–2.5, p = 0.019). The LCS complete knees had a significantly higher risk for revision with CAS, compared to CON (relative risk = 2.1 (95% CI 1.3–3.4, p = 0.004)). Mean operating time was 15 minutes longer in the CAS group. Conclusion. Survivorship at two years of computer navigated primary total knee replacements was inferior compared to conventionally operated knees. Therefore, an extensive use of CAS in primary total knee replacement surgery cannot be encouraged until proven superior in long term register studies and clinical trials

Background. There are few studies of total knee replacements with cemented tibia and uncemented femur (hybrid). Previous studies have not shown any difference in revision rate between different fixation methods, but these studies had few hybrid prostheses. This study evaluates the results of hybrid knee replacements based on data from the Norwegian Arthroplasty Register (NAR). Patients and Methods. Primary total knee replacements without patella resurfacing, reported to the NAR during the years 1999–2009, were evaluated. Hinged-, posterior stabilized- and tumor prostheses were excluded. LCS- and Profix prostheses with conforming plus bearing were included. With the risk for revision at any cause as the primary end-point, 2945 hybrid knee replacements (HKR) were evaluated against 20838 cemented knee replacements (CKR). Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex and preoperative diagnosis were used. Results. Kaplan-Meier estimated survival at 8 years was 94.0% (95% CI: 93.6–94.4) in the CKR group and 97.0% (95% CI: 96.0–98.0) in the HKR group. The HKR group was made op of three brands of prosthesis, LCS, LCS-complete and Profix. Profix was the only brand with a statistically significant difference between cemented and hybrid fixation. Kaplan-Meier estimated survival at 8 years was 97.7% (95% CI: 96.7–98.7) in hybrid Profix group (HPG) and 95.5% (95% CI: 94.7–96.3) in the cemented Profix group (CPG). The adjusted Cox regression analysis showed a statistically significantly lower risk for revision in the HPG group (relative risk=0.44, 95% CI: 0.39–0.59, p<0.001). Mean operating time was 15 minutes longer in the CKR group. Conclusion. Survivorship at 8 years of the hybrid primary total knee replacements was the same or superior compared to cemented total knee replacements depending on prosthesis brand Hybrid fixation seems to be a safe alternative to cemented fixation in total knee replacement surgery

Background. 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. Aim of study. 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). Methods. 8,636 patients (65 years and older) with displaced femoral neck fractures (Garden 3 and 4) operated with a cemented (n = 6,907) or a uncemented bipolar HA (n = 1,729) were selected from the files of The Norwegian Hip Fracture Register 2005–2009. Mortality was assessed using Kaplan-Meier survival analysis and risk factors of death were investigated using Cox-regression analysis. A power analysis showed the study sample to be sufficient to detect a difference in mortality of 3% at one year postoperatively. Results. Overall mortality one year postoperatively was 27%. We found no difference in the risk of death when comparing operation with cemented with uncemented bipolar HA one year (RR = 0.97, p = 0.51), 240 days (RR = 1.00, p = 0.95), 120 days (RR = 1.04, p = 0.57), and 30 days (RR = 1.12, p = 0.23) postoperatively. However, 10 days postoperatively there was an increased risk of death for patients operated with cemented HA compared to those operated with uncemented bipolar HA (RR = 1.34, p = 0.03). High age, male gender, cognitive impairment, increasing ASA score, and delay in surgery >48 hours after injury were all associated with an increased risk of death one year postoperatively. Interpretation. The early increased risk of death for patients operated with a cemented HA might be caused by the bone cement implantation syndrome. Our results further indicate that the difference in mortality one year postoperatively is likely to be less than 3%

Background. 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. Aim of the study. 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. Methods. 12,313 patients (65 years or older) with displaced femoral neck fractures (Garden 3 and 4) operated either with IF by two screws (n = 3,436) or a bipolar HA (n = 8,877) were selected from the files of The Norwegian Hip Fracture Register 2005–2009. Mortality was assessed using Kaplan-Meier survival analysis and risk factors for death were studied using Cox-regression analysis. A power analysis showed the study sample to be sufficient to detect a difference in mortality of 3% at one and three years postoperatively. Results. The overall one-year mortality was 28% and three-year mortality was 50%. High age, male gender, cognitive impairment, increasing ASA score and delay in surgery >48 hours after injury were all associated with increased risk of death. For patients operated with a bipolar HA there was a statistically significant increased risk of death at day 30 (RR = 1.30, p<0.01), day 120 (RR = 1.15, p = 0.01), and day 240 (RR = 1.10, p<0.01) postoperatively compared to IF by two screws. At one year (RR = 1.04, p = 0.28) and three years (RR = 1.05, p = 0.16) postoperatively, we found no difference in the risk of death when comparing operation with bipolar HA to IF by two screws. Interpretation. The mortality for patients with displaced femoral neck fractures was considerable and dependent on age, gender, ASA score, cognitive status, and timing of surgery. Given the small magnitude of the difference in short-term mortality and no difference in one- and three-year mortality (or at least less than 3%) between the two treatment groups, we do not believe our findings should influence the choice of treatment method

Aims

Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA).

Aims

The aims of this study were to investigate the mortality following a proximal humeral fracture. Data from a large population-based fracture register were used to quantify 30-day, 90-day, and one-year mortality rates after a proximal humeral fracture. Associations between the risk of mortality and the type of fracture and its treatment were assessed, and mortality rates were compared between patients who sustained a fracture and the general population.

This is the first study to use the English Indices of Multiple Deprivation 2007, the Government’s official measure of multiple deprivation, to analyse the effect of socioeconomic status on the incidence of fractures of the hip and their outcome and mortality. Our sample consisted of all patients admitted to hospital with a fracture of the hip (n = 7511) in Nottingham between 1999 and 2009.

The incidence was 1.3 times higher (p = 0.038) in the most deprived populations than in the least deprived; the most deprived suffered a fracture, on average, 1.1 years earlier (82.0 years versus 83.1 years, p < 0.001). The mortality rate proved to be significantly higher in the most deprived population (log-rank test, p = 0.033), who also had a higher number of comorbidities (p = 0.001).

This study has shown an increase in the incidence of fracture of the hip in the most deprived population, but no association between socioeconomic status and mortality at 30 days. Preventative programmes aimed at reducing the risk of hip fracture should be targeted towards the more deprived if they are to make a substantial impact.

We examined prospectively collected data from 6782 consecutive hip fractures and identified 327 fractures in 315 women aged ≤65 years. We report on their demographic characteristics, treatment and outcome and compare them with a cohort of 4810 hip fractures in 4542 women aged > 65 years.

The first significant increase in age-related incidence of hip fracture was at 45, rather than 50, which is when screening by the osteoporosis service starts in most health areas. Hip fractures in younger women are sustained by a population at risk as a result of underlying disease. Mortality of younger women with hip fracture was 46 times the background mortality of the female population. Smoking had a strong influence on the relative risk of ‘early’ (≤ 65 years of age) fracture.

Lag screw fixation was the most common method of operative treatment. General complication rates were low, as were re-operation rates for cemented prostheses. Kaplan-Meier implant survivorship of displaced intracapsular fractures treated by reduction and lag screw fixation was 71% (95% confidence interval 56 to 81) at five years. The best form of treatment remains controversial.

In a series of 450 patients over 70 years of age with displaced fractures of the femoral neck sustained between 1995 and 1997 treatment was randomised either to internal fixation or replacement. Depending on age and level of activity the latter was either a total hip replacement or a hemiarthroplasty. Patients who were confused or bed-ridden were excluded, as were those with rheumatoid arthritis. At ten years there were 99 failures (45.6%) after internal fixation compared with 17 (8.8%) after replacement. The rate of mortality was high at 75% at ten years, and was the same in both groups at all times. Patient-reported pain and function were similar in both groups at five and ten years. Those with successfully healed fractures had more hip pain and reduction of mobility at four months compared with patients with an uncomplicated replacement, and they never attained a better outcome than the latter patients regarding pain or function.

Primary replacement gave reliable long-term results in patients with a displaced fracture of the femoral neck.

This retrospective cohort study was conducted to investigate whether operative treatment of patients with a pertrochanteric femoral fracture outside working hours is associated with an increased risk of complications and higher mortality. During the study period 165 patients were operated on outside working hours and 123 were operated on during working hours (08.00 to 17.00). There was no difference in the rate of early complications (outside working hours 33% versus working hours 33%, p = 0.91) or total complications during follow-up (outside working hours 40% versus working hours 41%, p = 0.91). Both in-hospital mortality (outside working hours 12% versus working hours 11%, p = 0.97) and mortality after one year (outside working hours 29% versus working hours 27%, p = 0.67) were comparable. Adjustment for possible confounders by multivariate logistic regression analysis revealed no increased risk of complications when patients were operated on outside working hours.

On the basis of these data, there is no medical reason to postpone operative reduction and fixation in patients with a proximal femoral fracture until working hours.

We evaluated the cost and consequences of proximal femoral fractures requiring further surgery because of complications. The data were collected prospectively in a standard manner from all patients with a proximal femoral fracture presenting to the trauma unit at the John Radcliffe Hospital over a five-year period. The total cost of treatment for each patient was calculated by separating it into its various components. The risk factors for the complications that arose, the location of their discharge and the mortality rates for these patients were compared to those of a matched control group. There were 2360 proximal femoral fractures in 2257 patients, of which 144 (6.1%) required further surgery. The mean cost of treatment in patients with complications was £18 709 (£2606.30 to £60.827.10), compared with £8610 (£918.54 to £45 601.30) for uncomplicated cases (p < 0.01), with a mean length of stay of 62.8 (44.5 to 79.3) and 32.7 (23.8 to 35.0) days, respectively. The probability of mortality after one month in these cases was significantly higher than in the control group, with a mean survival of 209 days, compared with 496 days for the controls. Patients with complications were statistically less likely to return to their own home (p < 0.01).

Greater awareness and understanding are required to minimise the complications of proximal femoral fractures and consequently their cost.