High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

Poignard, Alexandre; Bouhou, Mohamed; Pidet, Olivier; Flouzat-Lachaniette, Charles-Henri; Hernigou, Philippe

doi:10.1007/s11999-011-1987-7

Cited by 31 publications

(19 citation statements)

References 26 publications

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“…However, acetabular erosion is a complication of both unipolar and bipolar HA (occurring in up to 36% and up to 26% of hips, respectively) in the first five years postoperatively and often leading to revision surgery. 7,9 A recent Cochrane review showed an increased risk ratio of 3.83 for acetabular erosion in patients with unipolar HA. 3 In order to overcome both drawbacks and combine the advantages of THR (less pain, better function) and HA (shorter surgical time, less blood loss, greater stability), a large metal femoral head coupled with a pliable, 2.7 mm thick hydrophilic polycarbonate-urethane (PCU) acetabular component (TriboFit Hip System; Active Implants Corp., Memphis, Tennessee) was introduced for the treatment of displaced femoral neck fractures.…”

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confidence: 99%

A comparison of hemiarthroplasty with a novel polycarbonate–urethane acetabular component for displaced intracapsular fractures of the femoral neck

Cadossi

Chiarello

Savarino

et al. 2013

The Bone & Joint Journal

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We undertook a randomised controlled trial to compare bipolar hemiarthroplasty (HA) with a novel total hip replacement (THR) comprising a polycarbonate-urethane (PCU) acetabular component coupled with a large-diameter metal femoral head for the treatment of displaced fractures of the femoral neck in elderly patients. Functional outcome, assessed with the Harris hip score (HHS) at three months and then annually after surgery, was the primary endpoint. Rates of revision and complication were secondary endpoints. Based on a power analysis, 96 consecutive patients aged > 70 years were randomised to receive either HA (49) or a PCU-THR (47). The mean follow-up was 30.1 months (23 to 50) and 28.6 months (22 to 52) for the HA and the PCU group, respectively. The HHS showed no statistically significant difference between the groups at every follow-up. Higher pain was recorded in the PCU group at one and two years' follow-up (p = 0.006 and p = 0.019, respectively). In the HA group no revision was performed. In the PCU-THR group six patients underwent revision and one patient is currently awaiting re-operation. The three-year survival rate of the PCU-THR group was 0.841 (95% confidence interval 0.680 to 0.926). Based on our findings we do not recommend the use of the PCU acetabular component as part of the treatment of patients with fractures of the femoral neck.

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confidence: 99%

A comparison of hemiarthroplasty with a novel polycarbonate–urethane acetabular component for displaced intracapsular fractures of the femoral neck

Cadossi

Chiarello

Savarino

et al. 2013

The Bone & Joint Journal

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“…Dislocation is the major concern after both HA and THA for displaced femoral neck fractures in elderly patients. Previous studies have shown that the postoperative dislocation rate is higher in THA than in HA [ 28 , 29 ], whereas other studies have indicated no increase in the complication rate, including dislocation rate, after THA [ 6 , 7 ]. Our results showed that the risk of hip dislocation during the postoperative in-hospital period was significantly higher in the THA group than in the HA group dislocation (RD, 2.74%; 95%CI, 2.21–3.27; p < 0.001) which we supposed to be the main cause of the higher risk of revision surgery in the THA group (RD, 2.82; 95%CI, 2.27–3.37; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Ogawa

Yoshii

Moriwaki

et al. 2020

JCM

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Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95%Confidence interval(CI), 2.21–3.27; p < 0.001; RD, 2.82; 95%CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.

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“… 24 , 25 In turn, clinical studies evaluating complications of arthroplasty for femoral neck fractures indicated higher primary and recurrent hip dislocation rates following THA as compared to HA. 28 , 29 This finding is likely due to the increased technical demands of THA, and any detrimental effects of procedural inexperience might be mitigated by high-volume arthroplasty hospitals.…”

Section: Discussionmentioning

confidence: 99%

Operative Mortality After Arthroplasty for Femoral Neck Fracture and Hospital Volume

Maceroli

Nikkel

Mahmood

et al. 2015

Geriatr Orthop Surg Rehabil

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Background:The purpose of the present study is to use a statewide, population-based data set to identify mortality rates at 30-day and 1-year postoperatively following total hip arthroplasty (THA) and hemiarthroplasty (HA) for displaced femoral neck fractures. The secondary aim of the study is to determine whether arthroplasty volume confers a protective effect on the mortality rate following femoral neck fracture treatment.Methods:New York’s Statewide Planning and Research Cooperative System was used to identify 45 749 patients older than 60 years of age with a discharge diagnosis of femoral neck fracture undergoing THA or HA from 2000 through 2010. Comorbidities were identified using the Charlson comorbidity index. Mortality risk was modeled using Cox proportional hazards models while controlling for demographic and comorbid characteristics. High-volume THA centers were defined as those in the top quartile of arthroplasty volume, while low-volume centers were defined as the bottom quartile.Results:Patients undergoing THA for femoral neck fracture rather than HA were younger (79 vs 83 years, P < .001), more likely to have rheumatoid disease, and less likely to have heart disease, dementia, cancer, or diabetes (all P < .05). Thirty-day mortality after HA was higher (8.4% vs 5.7%; P < .001) as was 1-year mortality (25.9% vs 17.8%; P < .001). After controlling for age, gender, ethnicity, and comorbidities, risk of mortality following THA was 21% lower (hazard ratio [HR] 0.79; P = .003) at 30 days and 22% lower (HR 0.78; P < .001) at 1 year than HA. Patients undergoing THA at high-volume arthroplasty centers had improved 1-year mortality when compared to those undergoing THA at low-volume hospitals (HR 0.55; P = .008).Conclusions:Based on this large, population-based study, there is no basis to assume THA carries a greater mortality risk after hip fracture than does standard HA, even when accounting for institutional volume of hip arthroplasty.

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High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

Cited by 31 publications

References 26 publications

A comparison of hemiarthroplasty with a novel polycarbonate–urethane acetabular component for displaced intracapsular fractures of the femoral neck

A comparison of hemiarthroplasty with a novel polycarbonate–urethane acetabular component for displaced intracapsular fractures of the femoral neck

Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Operative Mortality After Arthroplasty for Femoral Neck Fracture and Hospital Volume

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