Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Graulich, Tilman; Graeff, Pascal; Jaiman, Ashish; Nicolaides, Stine; Pacha, Tarek Omar; Örgel, Marcus; Macke, Christian; Omar, Mohamed; Krettek, Christian; Liodakis, Emmanouil

doi:10.1007/s00590-020-02819-8

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…Nevertheless, despite the fact that a causative association of fracture morphology and posterior wall morphology in patients with traumatic posterior hip dislocation could not be determined in our study, we can state that a significant correlation of posterior wall morphology and fracture morphology can be made with a sensitivity of up to 88.9%. This is in line with our previous observations in patients with posterior bipolar hip arthroplasty dislocations [10].…”

Section: Discussionsupporting

confidence: 94%

“…The method was adapted from Valera et al, who analyzed the acetabular shape and described the anterior and posterior acetabular coverage in healthy patients younger than 55 years without higher degrees of osteoarthritis [ 9 ]. Likewise, reduced posterior acetabular sector angle (PASA) and reduced posterior wall angle (PWA) were thought to be among the major patient-related specific factors influencing the risk for bipolar hemiarthroplasty dislocation [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

Graulich

Gräff

Pacha

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Smaller posterior acetabular walls have been shown to independently influence the risk for bipolar hip dislocation. We asked whether differences would also be observed in patients with traumatic posterior hip dislocation with and without posterior wall fractures. Methods Between 2012 and 2020 we observed 67 traumatic posterior hip dislocations. Of these, 43 traumatic posterior hip dislocations in 41 patients met the inclusion criteria. Eighteen dislocations were excluded with an acetabular fracture other than posterior wall fracture and six dislocations had insufficient computed tomography (CT) data. The mean age was 41 ± 11 years, 32 males and nine females. We observed 26 traumatic hip dislocations with posterior wall fractures and 17 without. All patients underwent polytrauma CT scans and postoperative/postinterventional pelvic CT scans. On axial CT-scans, posterior wall determining angles were measured. Results Patients with posterior wall fractures were not significantly older than patients without posterior wall fractures (42 ± 12 vs. 38 ± 10 years; p = 0.17). Patients without posterior wall fractures had significantly smaller posterior acetabular sector angles (84° ± 10°) than did patients with posterior wall fractures (105° ± 12°) (p < 0.01; OR 1.178). Likewise, the posterior wall angle was significantly smaller in patients without posterior wall fracture (62° ± 9°) than in those with posterior wall fractures (71° ± 8°) (p < 0.01; OR 1.141). Conclusion Both posterior acetabular sector angle and posterior wall angle are independent factors determining the posterior wall fracture morphology in patients with traumatic posterior hip dislocation. Age and the observed trauma mechanism did not differentiate between traumatic posterior hip dislocations with and without posterior wall fractures.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

Graulich

Gräff

Pacha

et al. 2022

Eur J Trauma Emerg Surg

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“…Postoperative pain, functional outcome, and differences in cost between the cohorts could also not be analyzed. Finally, dementia has been associated with an increased risk of re-interventions due to dislocation after hemiarthroplasty [25]. Re-interventions, however, were not captured in the current database and as such could not be reported.…”

Section: Discussionmentioning

confidence: 92%

Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws

Ioannidis

Ismail

Forssten

et al. 2021

Eur J Trauma Emerg Surg

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Introduction Dementia is common in patients with hip fractures and is strongly associated with increased postoperative mortality. The choice of surgical intervention for displaced femoral neck fractures (dFNF) in patients with dementia has been a matter of debate. This study aims to investigate how short- and long-term mortality differs between those who have been operated with hemiarthroplasty or pins/screws. Methods All patients with dementia and dFNF, i.e., Garden III and IV, who underwent primary emergency hip fracture surgery, with either hemiarthroplasty or pins/screws, in Sweden between Jan 1, 2008 and Dec 31, 2017 were eligible for inclusion in the current study. Patients were divided into two groups based on the surgical intervention: hemiarthroplasty and pins/screws. The primary outcome of interest was 30-day postoperative mortality, and the secondary outcome was 1-year postoperative mortality. Poisson and Cox regression analyses were performed both before and after propensity score matching. Results A total of 9394 cases met the inclusion criteria; 84% received hemiarthroplasty and 16% received pins/screws. In the unmatched analysis, the adjusted incidence rate ratio (IRR) for 30-day postoperative mortality was not affected by the chosen surgical method (adj. IRR 0.96, CI 95% 0.83–1.12, p = 0.629). After propensity score matching, similar results were observed with no difference in 30-day postoperative mortality (adj. IRR 0.89, CI 95% 0.74–1.09, p = 0.286). There was a statistically significant decrease in the risk of 1-year postoperative mortality in the hemiarthroplasty group compared to the pins/screws group, both before and after propensity score matching. Conclusion This study could not demonstrate any difference in 30-day mortality in patients with dementia and dFNFs when comparing hemiarthroplasty with pins/screws. Patients that received hemiarthroplasties did, however, have a lower risk of 1-year postoperative mortality.

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“…Similarly, Tsai et al analyzed 23 comorbidities and found that the only variables that predicted the need for revision surgery after THA for a hip fracture were end-stage renal disease, schizophrenia, and male sex 35 . Factors that have been identified as predictive of dislocation after hemiarthroplasty include surgical duration, dementia, surgical approach, and prosthesis-related factors 24,36,37 . We were unable to find evidence that the comorbidity burden or specific comorbidities other than dementia increased the risk of dislocation in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture

Tohidi

Mann

McIsaac

et al. 2023

Journal of Bone and Joint Surgery

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Background: The optimal treatment of older patients with a displaced femoral neck fracture remains a controversial topic. This study aimed to compare clinical outcomes across a matched group of patients with a femoral neck fracture treated with either hemiarthroplasty or total hip arthroplasty (THA).Methods: Routinely collected health-care databases were linked to create a population-based cohort of 49,597 patients ‡60 years old from Ontario, Canada, who underwent hemiarthroplasty or THA for a femoral neck fracture between 2002 and 2017. A propensity-score-matched cohort was created using relevant and available predictors of treatment assignment and outcomes of interest. Clinical outcomes consisting of hip dislocation, revision surgery, hospital readmission, and death were compared in the matched cohort using survival analysis.Results: Over 99% of THA patients (4,612) were adequately matched 1:1 to hemiarthroplasty patients (total matched cohort = 9,224). Patients treated with THA were at higher risk for hip dislocation at 30 days and 1 and 2 years postoperatively (2-year risk, 1.8% for THA versus 0.8% for hemiarthroplasty; p < 0.001). There was no difference in the short-term (30-day) or long-term (up to 10-year) risk of revision surgery between treatment groups. There was no significant difference in the risk of 30-day hospital readmission between groups. The risk of death at 1 year and 2 years postoperatively was lower for patients treated with THA.Conclusions: For patients with a hip fracture, shared decision-making should involve discussion of the potential higher risk of short-term hip dislocation after THA compared with hemiarthroplasty. The risk of revision surgery was similar between treatment groups at up to 10 years of follow-up.

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Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Cited by 8 publications

References 27 publications

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws

Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture

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