Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery

Magnuson, Justin A.; Griffin, Sean A; Hobbs, J.; D’Amore, Taylor; Hughes, Andrew; Sherman, Matthew; Arshi, Armin; Krueger, Chad A.

doi:10.1016/j.arth.2022.12.003

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Interestingly, we found little difference in mortality between patients treated surgically vs nonsurgically for other hip fracture locations. This may stem from differing levels of surgical intensity that may vary depending on the location of hip fracture (eg, femoral head and neck vs pertrochantric) and differences in postoperative rehabilitation strategies, which may contribute to higher risks of complications and other adverse events . Femoral head and neck fractures are often treated by arthroplasty, which results in more predictable mobility and thus may have contributed to improved rehabilitation and lower mortality in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia

Adler,

Xiang,

Shah

et al. 2024

JAMA Netw Open

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ImportanceThe decision for surgical vs nonsurgical treatment for hip fracture can be complicated among community-dwelling people living with dementia.ObjectiveTo compare outcomes of community-dwelling people living with dementia treated surgically and nonsurgically for hip fracture.Design, Setting, and ParticipantsThis retrospective cross-sectional study undertook a population-based analysis of national Medicare fee-for-service data. Participants included community-dwelling Medicare beneficiaries with dementia and an inpatient claim for hip fracture from January 1, 2017, to June 30, 2018. Analyses were conducted from November 10, 2022, to October 17, 2023.ExposureSurgical vs nonsurgical treatment for hip fracture.Main Outcomes and MeasuresThe primary outcome was mortality within 30, 90, and 180 days. Secondary outcomes consisted of selected post–acute care services.ResultsOf 56 209 patients identified with hip fracture (73.0% women; mean [SD] age, 86.4 [7.0] years), 33 142 (59.0%) were treated surgically and 23 067 (41.0%) were treated nonsurgically. Among patients treated surgically, 73.3% had a fracture of the femoral head and neck and 40.2% had moderate to severe dementia (MSD). Among patients with MSD and femoral head and neck fracture, 180-day mortality was 31.8% (surgical treatment) vs 45.7% (nonsurgical treatment). For patients with MSD treated surgically vs nonsurgically, the unadjusted odds ratio (OR) of 180-day mortality was 0.56 (95% CI, 0.49-0.62; P &lt; .001) and the adjusted OR was 0.59 (95% CI, 0.53-0.66; P &lt; .001). Among patients with mild dementia and femoral head and neck fracture, 180-day mortality was 26.5% (surgical treatment) vs 34.9% (nonsurgical treatment). For patients with mild dementia who were treated surgically vs nonsurgically for femoral head and neck fracture, the unadjusted OR of 180-day mortality was 0.67 (95% CI, 0.60-0.76; P &lt; .001) and the adjusted OR was 0.71 (95% CI, 0.63-0.79; P &lt; .001). For patients with femoral head and neck fracture, there was no difference in admission to a nursing home within 180 days when treated surgically vs nonsurgically.Conclusions and RelevanceIn this cohort study of community-dwelling patients with dementia and fracture of the femoral head and neck, patients with MSD and mild dementia treated surgically experienced lower odds of death compared with patients treated nonsurgically. Although avoiding nursing home admission is important to persons living with dementia, being treated surgically for hip fracture did not necessarily confer a benefit in that regard. These data can help inform discussions around values and goals with patients and caregivers when determining the optimal treatment approach.

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Section: Discussionmentioning

confidence: 99%

Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia

Adler,

Xiang,

Shah

et al. 2024

JAMA Netw Open

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Outcomes of conversion total hip arthroplasty for failed fixation of intertrochanteric fractures with monoblock distal-loading reconstruction stem

Soundarrajan,

Fanta,

Singh

et al. 2024

Eur J Orthop Surg Traumatol

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Risk Factors for Loss to Follow-up of Elderly Patients After Hip Fracture Surgery: A Retrospective Cohort Study

Rui,

Hui,

Mao

et al. 2024

Geriatr Orthop Surg Rehabil

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Introduction Non-attendance with scheduled postoperative follow-up visits remains a common issue in orthopaedic clinical research. The objective of this study was to identify the risk factors associated with loss to follow-up among elderly patients with hip-fracture postoperatively. Methods A retrospective analysis of 1-year post-surgery was performed on patients aged over 60 years who underwent hip-fracture surgery from January 2017 to March 2019. Based on their completion of the appointed follow-up schedule, the patients were classified into 2 groups: the Loss to Follow-up (LTFU) Group and the Follow-up (FU) Group. Clinical outcomes were evaluated by Functional Recovery Score (FRS) questionnaires. Telephone interviews were conducted with patients lost to follow-up to determine the reasons for non-attendance. A comparative analysis of baseline characteristics between the 2 groups was implemented, with further exploration of statistical differences through logistic regression. Results A total of 992 patients met the inclusion criteria were included in this study, of which 189 patients, accounting for 19.1%, were lost to follow-up 1 year postoperatively. The mean age of the patients in the LTFU Group was 82.0 years, significantly higher than the 76.0 years observed in the FU Group ( P < 0.001). The FRS for the LTFU Group was marginally higher than that of the FU group (84.0 vs 81.0), with no significant difference ( P = 0.060). Logistic regression analysis identified several significant predictors of noncompliance, including advanced age at surgery, femoral neck fracture, hip arthroplasty, long distance from residence to hospital, and the reliance on urban-rural public transportation for reaching the hospital. Conclusion Postoperative follow-up loss was prevalent among elderly patients with hip fractures. Our study indicated a constellation of risk factors contributing to noncompliance, including advanced age, transportation difficulties, long travel distance, femoral neck fracture and hip arthroplasty surgery.

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Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery

Cited by 3 publications

References 34 publications

Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia

Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia

Outcomes of conversion total hip arthroplasty for failed fixation of intertrochanteric fractures with monoblock distal-loading reconstruction stem

Risk Factors for Loss to Follow-up of Elderly Patients After Hip Fracture Surgery: A Retrospective Cohort Study

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