Hip Fracture in the Elderly: Partial or Total Arthroplasty?

Fokter, Samo K.; Fokter, Nina

doi:10.5772/31279

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…79 articles remained eligible from which 32 were included in this article, reporting the fracture of a modular femoral neck after primary THA. There were 25 case reports 16–40 and 7 clinical studies. 5,7,41–45 Figure 1 demonstrates the study selection process based on PRISMA guidelines.…”

Section: Resultsmentioning

confidence: 99%

Fracture of femoral neck in modular total hip arthroplasty: a systematic review of the literature

Solou,

Panagopoulos,

Tatani

et al. 2023

HIP International

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Background: Modular femoral stems have the advantage of anatomic hip reconstruction by restoring the femoral offset thus minimising the bearing surface wear, implant loosening and dislocation. Aim: This study aims to investigate the existing literature on modular neck fractures, to identify predisposing factors and guide the decision-making process in the management of these difficult cases. Methods: A systematic literature review was conducted until July 2022. PRISMA guidelines were followed, eligibility criteria were set, and methodology assessment of included studies was conducted based on MINORS criteria, size and primary outcome. Data were extracted and analysed thoroughly. Results: 5657 studies were initially screened; the full texts of 124 records were assessed and finally, 32 reports were included. There were 7 clinical studies and 25 case reports. A total of 4825 patients (5204 hips) with a mean age 62.38 years and a mean BMI 29.06 kg/m2 were analysed in the 7 clinical studies. The reported overall weighted revision rate was 0.86%, while the weighted mean modular neck fracture rate was 0.26%. The usual history was sudden experience of hip pain and instability. The average time interval to neck fracture was 4.57 (range 3–4.7) years and a long modular neck was identified in 91.17% of them. Data from case reports showed a mean age and average BMI of 55.85 and 31.63 kg/m2. 82.35% of the patients were male. Necks were fractured after an average time interval of 64.5 ± 8.8 months. Conclusions: The incidence of modular neck fracture is significant. The profile of a male, obese patient with a long modular neck increased risk of neck fracture. Microstructural investigation of the retrieved implants demonstrated a higher incidence of fracture line in the base of the neck junction and at its anterolateral distal part. Surgeons should be aware of this complication while using or revising such protheses.

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Section: Resultsmentioning

confidence: 99%

Fracture of femoral neck in modular total hip arthroplasty: a systematic review of the literature

Solou,

Panagopoulos,

Tatani

et al. 2023

HIP International

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Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture

Pangaud,

Pauly,

Jacquet

et al. 2023

Sci Rep

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Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056–1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731–0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067–1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.

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Hip Fracture in the Elderly: Partial or Total Arthroplasty?

Cited by 2 publications

References 30 publications

Fracture of femoral neck in modular total hip arthroplasty: a systematic review of the literature

Fracture of femoral neck in modular total hip arthroplasty: a systematic review of the literature

Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture

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