Total Hip Arthroplasty For Femoral Neck Fracture

Sassoon, Adam; D’Apuzzo, Michele R.; Sems, Stephen A.; Cass, Joseph R.; Mabry, Tad M.

doi:10.1016/j.arth.2013.01.027

Cited by 46 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During this study four patients (two THR and two TKR) developed postoperative fevers (data not shown), although there was no overall significant temperature increase following THR and TKR surgery. Although, previous studies have been performed to investigate fevers and orthopaedic surgery [ 10 - 13 ], this study confirmed that developing fevers post-surgery is still a postoperative complication to be considered and treated by medical officers and surgeons. Interestingly, the fevers that developed during the current study occurred without any infection, which may suggest that this may be a normal physiological response to surgery in certain patients.…”

Section: Discussionsupporting

confidence: 70%

See 1 more Smart Citation

Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

Hughes

Hendricks

Edwards³

et al. 2013

Eur J Med Res

View full text Add to dashboard Cite

BackgroundWith an aging society and raised expectations, joint replacement surgery is likely to increase significantly in the future. The development of postoperative complications following joint replacement surgery (for example, infection, systemic inflammatory response syndrome and deep vein thrombosis) is also likely to increase. Despite considerable progress in orthopaedic surgery, comparing a range of biological markers with the ultimate aim of monitoring or predicting postoperative complications has not yet been extensively researched. The aim of this clinical pilot study was to test the hypothesis that lower limb orthopaedic surgery results in changes to coagulation, non-specific markers of inflammation (primary objective) and selective clinical outcome measures (secondary objective).MethodsTest subjects were scheduled for elective total hip replacement (THR) or total knee replacement (TKR) orthopaedic surgery due to osteoarthritis (n = 10). Platelet counts and D-dimer concentrations were measured to assess any changes to coagulation function. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as markers of non-specific inflammation. Patients were monitored regularly to assess for any signs of postoperative complications, including blood transfusions, oedema (knee swelling), wound infection, pain and fever.ResultsTHR and TKR orthopaedic surgery resulted in similar changes of coagulation and non-specific inflammatory biomarkers, suggestive of increased coagulation and inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in an increase in platelet (P = 0.013, THR) and D-dimer (P = 0.009, TKR) concentrations. Evidence of increased inflammation was demonstrated by an increase in CRP and ESR (P ≤ 0.05, THR and TKR). Four patients received blood transfusions (two THR and two TKR patients), with maximal oedema, pain and aural temperatures peaking between days 1 and 3 postoperatively, for both THR and TKR surgery. None of the patients developed postoperative infections.ConclusionsThe most noticeable changes in biological markers occur during days 1 to 3 postoperatively for both THR and TKR surgery, and these may have an effect on such postoperative clinical outcomes as oedema, pyrexia and pain. This study may assist in understanding the postoperative course following lower limb orthopaedic surgery, and may help clinicians in planning postoperative management and patient care.

show abstract

Section: Discussionsupporting

confidence: 70%

“…Previous studies have demonstrated the effect of various orthopaedic interventions on surgical complications [ 9 - 13 ]. Despite considerable progress in the field of orthopaedic surgery, surgical complications still exist.…”

Section: Introductionmentioning

confidence: 99%

Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

Hughes

Hendricks

Edwards³

et al. 2013

Eur J Med Res

View full text Add to dashboard Cite

show abstract

“…29 Because of these increased risks, we hypothesized that overall hospital arthroplasty expertise would reduce short-term complications following femoral neck fracture much in the same way high hospital volume exerts a protective effect in elective arthroplasty. 18,30,31 We found no significant differences in 90-day pulmonary embolism, deep vein thrombosis, joint infection, acute dislocation, and 1-year revision arthroplasty on pairwise comparisons between the volume quartiles.…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Femoral Neck Fractures: Improved Outcomes With Higher Hospital Volumes

Maceroli

Nikkel

Mahmood

et al. 2016

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objectives To determine if hospital arthroplasty volume affects patient outcomes after undergoing total hip arthroplasty for displaced femoral neck fractures. Methods The Statewide Planning and Research Cooperative System database from the New York State Department of Health was used to group hospitals into quartiles based on overall total hip arthroplasty (THA) volume from 2000–2010. The database was then queried to identify all patients undergoing THA specifically for femoral neck fracture during this time period. The data was analyzed to investigate outcomes between the four volume quartiles in 30-day and 1-year mortality, 1-year revision rate, and 90-day complication rate (readmission for dislocation, deep vein thrombosis, pulmonary embolism, prosthetic joint infection, or other complications related to arthroplasty in the treatment of femoral neck fractures with total hip arthroplasty). Results Patients undergoing THA for femoral neck fracture at hospitals in the top volume quartile had significantly lower 30-day (0.9%) and 1-year (7.51%) mortality than all other volume quartiles. There were no significant differences on pairwise comparisons between the second, third, and fourth quartiles with regard to post-operative mortality. There was no significant difference in revision arthroplasty at 1 year between any of the volume quartiles. On Cox regression analysis, THA for fracture at the lowest volume (4th) quartile (Hazard Ratio (HR) 1.91; p=0.016, 95% Confidence Interval (CI) [1.13–3.25]), second lowest volume (3rd) quartile (HR 2.01; p=0.013, 95% CI [1.16–3.5) and third lowest volume (2nd) quartile (HR 2.13; p=0.005, 95% CI [1.26–3.62]) were associated with increased risk for a 1-year postoperative mortality event. Hospital volume quartile was also a significant risk factor for increased 90-day complication (PE/DVT, acute dislocation, prosthetic joint infection) following THA for femoral neck fracture. Having surgery in the fourth quartile (HR 2.71; p<0.001, 95% CI [1.7–4.31]), third quartile (HR 2.61; p<0.001, 95% CI [1.61–4.23) and second quartile (HR 2.41; p<0.001, 95% CI [1.51–3.84]) all were significant risk factors for increased 90-day complication risk. Conclusions The results of this population-based study indicate that THA for femoral neck fractures at high-volume arthroplasty centers is associated with lower mortality and 90-day complication rates but does not influence 1-year revision rate. THA for femoral neck fractures at top arthroplasty volume quartile hospitals are performed on healthier patients more quickly. Patient health is a critical factor that influences mortality outcomes following THA for femoral neck fractures.

show abstract

“… 5 , 9 – 13 In general, THA has been recommended for younger, more active patients, whereas HA has been recommended for older, lower demand patients. 4 , 12 , 13 Sassoon et al 14 demonstrated that THA has the potential for improved function, less long-term postoperative pain, and lower reoperation rates. However, these potential benefits may be associated with a higher risk of perioperative complications and increased anesthesia time.…”

Section: Introductionmentioning

confidence: 99%

“…Total hip arthroplasty has been shown to require longer surgical times, increased blood loss, higher transfusion rates, pulmonary embolism, and mortality as compared to HA and internal fixation but can provide better outcomes and lower cost in the long term for younger patients. 14 A better understanding of trends in overall health care, surgical management, and the risk factors associated with perioperative complications in this population is needed.…”

Section: Introductionmentioning

confidence: 99%

Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

Grau

Summers

Massel

et al. 2018

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction:There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied.Methods:Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications.Results:Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly.Discussion:Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications.Conclusion:Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population.

show abstract

Total Hip Arthroplasty For Femoral Neck Fracture

Cited by 46 publications

References 11 publications

Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

Total Hip Arthroplasty for Femoral Neck Fractures: Improved Outcomes With Higher Hospital Volumes

Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

Contact Info

Product

Resources

About