Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial

Bjørnelv, Gudrun Maria Waaler; Frihagen, Frede; Madsen, Jan Erik; Nordsletten, Lars; Aas, Eline

doi:10.1007/s00198-011-1772-1

Cited by 40 publications

(18 citation statements)

References 34 publications

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“…A higher rate of dislocation was reported previously in total hip replacement [16], [18]. In patients using a posterolateral approach during the surgery, reported incidence of dislocation ranged between 13% to 22% [18], [22]–[24]. Potential risk factors leading to dislocation include component design, operative approach, and around soft-tissue tensioning [25].…”

Section: Discussionmentioning

confidence: 85%

Outcome of Hemiarthroplasty and Total Hip Replacement for Active Elderly Patients with Displaced Femoral Neck Fractures: A Meta-Analysis of 8 Randomized Clinical Trials

Zhao

Chen

et al. 2014

PLoS ONE

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BackgroundDisplaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis.MethodsA literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted.ResultsA total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: −7.11, 95%:−10.70,−3.53) one year postoperatively and the advantage kept over (SMD: −6.91, 95%:−12.98, −0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19).ConclusionEven though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.

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Section: Discussionmentioning

confidence: 85%

Outcome of Hemiarthroplasty and Total Hip Replacement for Active Elderly Patients with Displaced Femoral Neck Fractures: A Meta-Analysis of 8 Randomized Clinical Trials

Zhao

Chen

et al. 2014

PLoS ONE

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“…The literature supports the use of the former method; in patients older than 60 years, HA reportedly results in fewer re-operations compared with internal fixation [10]. HA is also the most cost-effective surgical treatment available [11].…”

Section: Introductionmentioning

confidence: 84%

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Hongisto

Pihlajamäki

Niemi³

et al. 2014

International Orthopaedics (SICOT)

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Purpose For femoral neck fractures, recent scientific evidence supports cemented hemiarthroplasty (HA) over uncemented HA and suggests that total hip arthroplasty (THA) should be performed more frequently. We report the current surgical trends in treating femoral neck fractures in Finland. Methods The study was conducted using the Finnish National Hospital Discharge Register and included all Finns at least 50 years of age who underwent surgery for femoral neck fractures from 1998 through 2011. Age-and sex-specific incidence rates and annual proportion of each treatment method were calculated. Results During 1998-2011, a total of 49,514 operations for femoral neck fracture were performed in Finland. The proportion of uncemented HA increased from 8.1 % in 2005 to 22.2 % in 2011. During the same time, the proportion of cemented HA decreased from 63.9 to 52.5 %, internal fixation decreased from 23.2 to 16.1 % and THA increased from 4.9 to 9.2 %. Conclusions Between 2005 and 2011, the proportion of uncemented HA for femoral neck fractures increased markedly in Finland, while cemented HA and internal fixation declined. During this time, the use of THA nearly doubled. The current evidence-based guidelines for treatment of femoral neck fractures were mainly followed, but the increase in uncemented HA procedures contradicts recent scientific evidence.

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“…For patients under 60 years of age with a displaced fracture (Garden type 3 or 4), hemiarthroplasty was preferred by 11 % and 25 % of respondents, respectively [ 7 ]. Although initial costs for arthroplasty are higher than for internal fixation, arthroplasty has been proven to be a cost-effective therapy [ 8 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

et al. 2016

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Summary The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi-or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness. Introduction The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi-or total hip arthroplasty in fit elderly patients. Methods The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi-or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data. Results Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %. Conclusions The main cost determinants for hemi-or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

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Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial

Abstract: Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

Cited by 40 publications

References 34 publications

Outcome of Hemiarthroplasty and Total Hip Replacement for Active Elderly Patients with Displaced Femoral Neck Fractures: A Meta-Analysis of 8 Randomized Clinical Trials

Outcome of Hemiarthroplasty and Total Hip Replacement for Active Elderly Patients with Displaced Femoral Neck Fractures: A Meta-Analysis of 8 Randomized Clinical Trials

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

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