Is Functional Outcome Better After Arthroplasty for Trochanteric Fractures in Older Adults?

Abstract

Objectives:This article evaluated functional recovery and mortality after surgery to repair trochanteric fracture with regard to treatment technique through one year of follow-up. Method:Eighty consecutive patients with trochanteric fractures were divided into two groups according to treatment technique (osteosynthesis and arthroplasty). We evaluated patient data including age, sex, time to surgery, total hospital stay, transfusion volume, and functional status according to FIM (Functional Independence Measure) scores. Scores for FIM were assessed three times: prior to fracture, six months after surgery, and one year after surgery. Results:Patients who received osteosynthesis had shorter hospital stays than arthroplasty patients. The arthroplasty group had significantly higher functional independence six months after surgery, while no difference was detected one year after surgery. Patient age, transfusion volume, and FIM scores were detected as significant predictors of mortality. Conclusion:Trochanteric fractures lead to unavoidable functional loss, although this can be reduced in the short term by treating with arthroplasty instead of osteosynthesis. Age, transfusion and functional situation predict one-year mortality for patients with trochanteric fractures. The patient’s functional situation must be considered when choosing treatment for trochanteric fractures in order to reduce patient morbidity. Level of Evidence II; Therapeutic prospective study.

Super elderly patients with intertrochanteric fractures do not predict worse outcomes and higher mortality than elderly patients: a propensity score matched analysis

“…Functional outcomes after hip fracture surgeries are likely to be multifactorial. Numerous studies [ 11 – 14 , 16 ] have shown that age, gender, ASA-grade, transfusion requirement/volume and comorbidities were predictors of morbidity and mortality after surgery for hip fractures. In addition, the impact of other factors, such as surgery delay, type of anesthesia, duration of operation, and volume of intraoperative blood loss, have not been consistently demonstrated.…”

“…To the best of our knowledge, the possible role of age is still under discussion. Several previous publications [ 11 – 15 ] have shown that functional impairment increases with age, while others [ 16 – 20 ] have suggested that age is not associated with adverse outcomes. However, relevant research on whether super elderly patients aged over 90 years have significantly worse functional outcomes and survival rates than others is still limited.…”

Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

“…Results of comparative studies are, however, inconsistent, with some studies reporting a lower mortality rate of IF than HA [ 33 , 34 ] and others a similar mortality rate between both treatment methods [ 35 , 36 , 37 ]. Female gender, age over 80 years old, lower functional level before the injury, chronic pulmonary diseases, diabetes, ASA score 3 or 4, volume of blood transfusion, increased time between injury and surgery, and total length of hospital stay are other risk factors identified for increased mortality after surgical treatment of IFFs by IM or HA [ 16 , 27 , 38 ].…”

“…For Xie et al [ 15 ], HA was an option to allow early mobilization and improve the quality of life of patients > 80 years old with preinjury ambulatory capacity who were able to tolerate surgery. Öztürk et al [ 16 ] found a powerful correlation between mortality and patient’s functional status and believed that HA should be reserved for patients with low functional demands who would not tolerate further functional loss in a short time period. However, they suggested that IF should preferably be used in patients with an adequate functional level.…”

İntertrokanteri̇k Kalça Kiriği Cerrahi̇si̇nde, Genel Veya Spi̇nal Anestezi̇ Terci̇hi̇ Kapali Redüksi̇yonun Kali̇tesi̇ni̇ Ve Kalça Eklem Fonksi̇yonunu Etki̇ler Mi̇?

“…Ortopedik cerrahi bir implantın her ne kadar enfeksiyon benzeri bazı riskleri bulunsa da (6) bu kırıkların cerrahi dışı tedavisi yüksek morbidite ve mortalite nedeniyle yalnızca kısıtlı bir hasta grubu için geçerli olabilir (7). İntertorkanterik kırığı olan yaşlı hastaların cerrahisinde en sık kullanılan yöntemler, proksimal kalça çivileri ve artroplastidir (8). Kalça çivisi, intertrokanterik kalça kırıklarının tedavisi için en sık kullanılan yöntemdir.…”