Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial

Bhandari, Mohit; Devereaux, P. J.; Einhorn, Thomas A.; Thabane, Lehana; Schemitsch, Emil H.; Koval, Kenneth J.; Frihagen, Frede; Poolman, Rudolf W.; Tetsworth, Kevin; Guerra-Farfán, Ernesto; Madden, Kim; Sprague, Sheila; Guy, Pierre

doi:10.1136/bmjopen-2014-006263

Cited by 61 publications

(39 citation statements)

References 40 publications

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“…There is growing consensus that, for individuals with hip fracture but reasonable underlying health status, THA (or HA) offers better functional outcomes with acceptable surgical risk . A number of large randomized trials are under way that will attempt to definitively answer questions about which individuals with hip fracture should undergo THA or HA . The current study findings suggest that clinical practice is evolving to reflect recent research demonstrating benefits of THA particularly for femoral neck fractures.…”

Section: Discussionmentioning

confidence: 89%

Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data

Cram

Yan

Bohm

et al. 2016

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 89%

Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data

Cram

Yan

Bohm

et al. 2016

J American Geriatrics Society

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“…The main drawback to performing total hip arthroplasty for femoral neck fractures is the risk of dislocation(9). While total hip arthroplasty patients had a higher hazard of dislocation than hemiarthroplasty, the cumulative incidence of dislocation at 2 years was 2.9%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fracture: A Medicare Cohort Study

Wang

Bhattacharyya²

2017

Journal of Orthopaedic Trauma

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Objectives For patients with femoral neck fractures, total hip arthroplasty demonstrates superior outcomes compared to hemiarthroplasty. However hemiarthroplasty remains a common treatment for femoral neck fractures and the conversion rates are unknown. We compared the results of the two procedures utilizing a Medicare database. Methods We assembled a cohort of 70,242 patients age 65 to 90 with an ICD9 diagnosis and matching Current Procedure terminology (CPT) code for femoral neck fracture between 2008 and 2012. Patients were followed forward for two years minimum. Incidences of dislocation and mortality were measured. Reoperation for revision of total hip arthroplasty or conversion of hemiarthroplasty to total hip arthroplasty was assessed by CPT code. Groups were compared via proportional hazard models controlling for age, race, sex and comorbidity index. Results Hemiarthroplasty represented 95% of the patients treated using arthroplasty for femoral neck fracture. The proportional hazard of reoperation and dislocation were significantly lower for hemiarthroplasty than total hip arthroplasty (p<0.0001 for both). At two years, fewer than 2% of hemiarthroplasty patients underwent conversion to total hip replacement. Patients treated with total hip arthroplasty were more likely to be alive at two years (adjusted hazard ratio=1.67, 95% Confidence Interval: 1.59 to 1.92). Conclusion Patients treated with hemiarthroplasty following femoral neck fractures had significantly lower proportional hazard of reoperation than those treated with total hip arthroplasty. Total hip arthroplasty may be associated with lower mortality. Level of Evidence Therapeutic, Level III.(1)

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“…Treatment options include THA and bipolar hemiarthroplasty [2,12,18,26]. The optimal surgical treatment of displaced femoral neck fractures is still debated.…”

Section: Discussionmentioning

confidence: 99%

“…Femoral neck fractures are among the leading causes of mortality and disability and their prevalence is expected to increase [2]. Treatment options include THA and bipolar hemiarthroplasty [2,12,18,26].…”

Section: Discussionmentioning

confidence: 99%

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Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond

Roth

Abdel

Harmsen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Displaced femoral neck fractures frequently are treated with bipolar hemiarthroplasties. Despite the frequency with which bipolar hemiarthroplasty is used to treat these fractures, there are few long-term data. Questions/purposes We sought to evaluate (1) the cumulative incidence of revision for any reason of bipolar hemiarthroplasties at 20 years, and the proportion of patients who lived more than 20 years who still have the prosthesis in situ from the index arthroplasty, (2) the cumulative incidence of aseptic loosening at 20 years, and (3) the Harris hip score of the surviving patients at long term.Methods We performed 376 cemented bipolar hemiarthroplasties for displaced femoral neck fractures in 359 patients between 1976 and 1985. At a minimum of followup of 20 years (mean, 24 years; range, 20-31 years), 339 of 359 patients (94%) were deceased, leaving 20 patients in the study group. Of those, one patient was confirmed to be lost to followup and two others had radiographic followup only. Three hundred fifty-nine patients (99.2%) (376 of the original 379 hips) were followed until death, revision of the hemiarthroplasty, or for at least 20 years (of clinical followup). Bipolar hemiarthroplasty was performed for displaced femoral neck fractures. Cemented fixation was the standard of care between 1976 and 1985 at our institution. The mean age of the patients at the time of surgery was 79 years (range, 60-99 years). The cumulative incidence of revision, estimated with death as a competing risk, and radiographs were evaluated for signs of aseptic loosening by a surgeon not involved in the clinical care of the patients. Clinical function was evaluated with the Harris hip score. The mean age of the patients at the time of surgery was 79 years. Results The 20-year cumulative incidence of revision for any reason was 3.5% (95% CI, 1.6%-5.3%). Of the 20 patients who survived more than 20 years, seven had the implant intact. The 20-year cumulative incidence of revision for aseptic loosening was 1.4% (95% CI, 0.2%-2.6%). The mean Harris hip score in patients who were still living and patient who did not have revision surgery was 63 ± 22, however 13 of the 20 patients had undergone revision surgery. Conclusions The long-term survivorship of bipolar hemiarthroplasty prostheses used to treat displaced femoral neck fractures in the elderly was high, and the procedure can be considered definitive for the majority of elderly patients with a femoral neck fracture. In this series, 6%

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Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial

Cited by 61 publications

References 40 publications

Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data

Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data

Outcomes of Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fracture: A Medicare Cohort Study

Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond

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