Preoperative Factors Influencing Decision Between Hemiarthroplasty and Total Hip Arthroplasty in Femoral Neck Fractures in Indian Patients—Retrospective Single-Center Study

Abstract

Introduction:The percentage of elderly population is increasing worldwide, with increasing incidence of femoral neck fractures. An increasing trend of arthroplasty for femoral neck fracture is observed. We aim to retrospectively analyze the preoperative factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty for managment of the same.Materials and Methods:Patients admitted with femoral neck fracture during January 2010 to March 2015 in our institute were included in the study. The preinjury independency status was assessed using Katz index scoring system. Based on the data obtained from case sheets, the patients were segregated into hemiarthroplasty group and total hip arthroplasty group. Variables that preferentially appeared in the individual group were identified.Results:A total of 206 hips of 199 patients were included in the study. The factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty with a statistical significance were age, Katz index score, and American Society of Anesthesiologists (ASA) grade. Higher ASA grades caused delay in surgery, increasing the length of hospital stay, and these patients more commonly underwent hemiarthroplasty.Discussion:Patients’ preinjury functional status influenced the decision between hemiarthroplasty and total hip arthroplasty, especially in the age between 65 and 80 years. Preoperative comorbidities did not prevent the patient from undergoing total hip replacement due to early optimization for surgery with the help of the dedicated orthogeriatric team.Conclusion:We conclude that preinjury functional independency of a patient is an important decisive factor in the choice between hemiarthroplasty and total hip arthroplasty. In addition to other factors including age and comorbidity pattern, scoring methods for preinjury functional status of patient could aid in decision-making. Early optimization, early surgery, and faster rehabilitation help the patients to achieve their preinjury functional status.

Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery

“…Patient baseline health conditions measured using CARES were classified into 4 risk groups: Low (0-10), Low-Moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), Moderate-high (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and High (>30). From the Low-Moderate (6%) rate, mortality rates approximately doubled with successive increases to Moderate-High (17%) and then to High (33%) (Figure 1).…”

“…Decision-making regarding treatment and peri-operative surgical management are often guided by the patient’s comorbidities assessed via various health matrices such as ASA-PS and D-CCI. 20 , 21 …”

“…Decision-making regarding treatment and peri-operative surgical management are often guided by the patient's comorbidities assessed via various health matrices such as ASA-PS and D-CCI. 20,21 The ASA-PS classification system was first introduced in 1941 by Saklad et al and has since been revised multiple times to improve objectivity and inter-rater variability. Despite the latest revised scoring scheme and the addition of case vignettes designed to improve grading accuracy, the ASA-PS classification relies on not only comorbidity presence but on severity as well in determining a grade.…”