This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days. We analyzed data from 26,393 patients with trochanteric AO/OTA A1 and A2 fractures treated with IMNs (n = 9,095) or SHSs (n = 17,298) in the Norwegian Hip Fracture Register (January 2008 to December 2020). Exclusions were made for patients aged < 60 years, pathological fractures, pre-2008 operations, contralateral hip fractures, fractures other than trochanteric A1/A2, and treatments other than IMNs or SHSs. Kaplan-Meier and Cox regression analyses adjusted for type of fracture, age, sex, cognitive impairment, American Society of Anesthesiologists (ASA) grade, and time period were conducted, along with calculations for number needed to harm (NNH).Aims
Methods
Displaced femoral neck fractures in elderly are normally treated with 2 screws/pins (IF) or bipolar hemiarthroplasty (HA). The aim of this study was to compare IF and HA as treatment for displaced femoral neck fractures using reoperations and functional result (patient satisfaction, pain, and quality of life) as outcome. From January 2005 all hip fractures in Norway are reported to the Norwegian Hip Fracture Register. At 4, 12, and 36 months postoperatively a questionnaire assessing satisfaction (VAS 0-100), pain (VAS 0-100), and quality of life (EQ-5D) is sent to the patients. To ensure more than 3 years follow-up, only patients operated in 2005 were included in the present study. Consequently 1,968 patients over 70 years of age operated with IF (n = 958) or HA (n = 1,010) due to displaced femoral neck fractures were included in the analyses on reoperations. Of these, 280 patients responded to all questionnaires and were included in the analyses on functional results (IF: n = 135, HA: n = 145). The patients remained in the same treatment group according to the intention-to-treat principle.Introduction
Material and Methods
Using data from the Norwegian Hip Fracture Register,
8639 cemented and 2477 uncemented primary hemiarthroplasties for
displaced fractures of the femoral neck in patients aged > 70 years
were included in a prospective observational study. A total of 218
re-operations were performed after cemented and 128 after uncemented
procedures. Survival of the hemiarthroplasties was calculated using
the Kaplan-Meier method and hazard rate ratios (HRR) for revision
were calculated using Cox regression analyses. At five years the
implant survival was 97% (95% confidence interval (CI) 97 to 97)
for cemented and 91% (95% CI 87 to 94) for uncemented hemiarthroplasties.
Uncemented hemiarthroplasties had a 2.1 times increased risk of
revision compared with cemented prostheses (95% confidence interval
1.7 to 2.6, p < 0.001). The increased risk was mainly caused
by revisions for peri-prosthetic fracture (HRR = 17), aseptic loosening
(HRR = 17), haematoma formation (HRR = 5.3), superficial infection
(HRR = 4.6) and dislocation (HRR = 1.8). More intra-operative complications,
including intra-operative death, were reported for the cemented
hemiarthroplasties. However, in a time-dependent analysis, the HRR
for re-operation in both groups increased as follow-up increased. This study showed that the risk for revision was higher for uncemented
than for cemented hemiarthroplasties.
