Functional Outcome After Successful Internal Fixation Versus Salvage Arthroplasty of Patients With a Femoral Neck Fracture

Abstract

Objectives To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design Secondary cohort study to a randomized controlled trial. Setting Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals Patients Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention None (observatory study) Main outcome measurements Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Results Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio −8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median −25.4 versus −20.4 N, P=0.025). Conclusion Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture.

Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients

“…There is still the ongoing discussion, whether primary arthroplasty or internal fixation is the better treatment option in younger patients [ 4 – 6 , 9 , 13 – 15 ]. While internal fixation tries to preserve the joint, there is a significant risk of implant failure, revision surgery, and avascular femoral head necrosis following femoral neck fractures and internal fixation.…”

“…While internal fixation tries to preserve the joint, there is a significant risk of implant failure, revision surgery, and avascular femoral head necrosis following femoral neck fractures and internal fixation. Up to 27% salvage arthroplasty were reported in a previous study [ 9 ]. We observed a comparatively low rate of secondary hip replacement of 16%, which might be explained in part by the relatively high number of patients lost to follow-up.…”

“…Shortening of bones in the lower extremity leads to leg length discrepancy (LLD) causing pain, osteoarthritis, gait disturbance and impaired mobility [ 2 , 8 ]. Due to lower functional demands and reduced mobility prior to the fracture, LLD following femoral neck fracture fixation in geriatric patients is often negligible [ 6 , 9 ]. On the other hand, posttraumatic LLD can lead to major long-term complaints in young patients with long life expectancy [ 2 , 8 ].…”

Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients

“…In the latter one, total hip arthroplasty (THA) or hemiarthroplasty is necessary as a "salvage" procedure to maintain hip joint mobility and stability. 11,12 For that reason, the surgeon must not only remove the failed fixation first but also adapt the acetabular and femoral components of the endoprosthesis because of the more pathological situs, for example, an unstable trochanteric fragment or acetabular defect zone. 13 Therefore, THA after failed osteosynthesis has also been reported with both higher complication and dislocation rates.…”

Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability

“…Additionally, 11 domain-specific measures were reviewed: three measures of emotional wellbeing -Geriatric Depression Scale (GDS) [42], Hamilton Rating Scale for Depression (HAM-D) [43] and the Zung Depression Inventory (ZungDI) [44]; and eight measures of (instrumental) activities of daily living (I/ADL): Barthel Index (BI) [45], Modified-Barthel Index [46], Functional Activities Index (FAI) [47], Functional Independence Measure (FIM) [48], Functional Status Questionnaire (FSQ) [49], Lawton IADL scale (Lawton-IADL) [50], Katz Index of Independence in ADL (Katz ADL) [51] and the OARS Multi-dimensional Functional Assessment Questionnaire (OMFAQ) [52]. One of these measures (Katz ADL) is clinician-completed but was included in the review due to its wide-spread use in this patient population.…”