Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture

Macaulay, William; Nellans, Kate W.; Iorio, Richard; Garvin, Kevin L.; Healy, William L.; Rosenwasser, Melvin P.

doi:10.1007/s11420-007-9061-4

Cited by 55 publications

(90 citation statements)

References 26 publications

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“…Subtrochanteric fractures have been reported for in situ pinning, and several studies, similar to ours, have a small number of patients with new femur fractures below the screws [6,20,21,24]. However this is not common.…”

Section: Discussionsupporting

confidence: 68%

“…Reoperations after internal fixation for nondisplaced femoral neck fractures in their study was 15.1%, which is similar to our rate; and they also reported that 3% had minor procedures such as screw removal for their nondisplaced fracture group and another 1.5% had a major reoperation. Other studies looking at nondisplaced femoral neck fractures had reoperation rates of 9% to 31% [3,4,11,21,24]. In these studies, the proportion of hips treated with nonarthroplasty procedures varied from 1.7% to 6%.…”

Section: Discussionmentioning

confidence: 99%

“…However, we found a higher-than-expected number of patients undergoing repeat surgery and conversion surgery to THA at relatively short-term followup. Some studies have raised similar concerns [18,24]. Treatment of these injuries appears to be more complex than previously thought, and there may be a role for either nonoperative treatment, a different fixation device or method such as a sliding hip screw or other fixed-angle device, or perhaps early arthroplasty in selected, although as yet uncharacterized patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have evaluated the epidemiology and clinical results of treatment of these injuries [1,2,4,5,8,9,11,[16][17][18][19]24]. Hip fractures in the elderly are associated with nearly 50% mortality at 5 years and more than 1 .…”

Section: Introductionmentioning

confidence: 99%

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Revision Surgery Occurs Frequently After Percutaneous Fixation of Stable Femoral Neck Fractures in Elderly Patients

Kain

Marcantonio

Iorio

2014

Clin Orthop Relat Res

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Background Femoral neck fractures are a major public health problem. Multiple-screw fixation is the most commonly used surgical technique for the treatment of stable femoral neck fractures. Questions/purposes We determined (1) the proportion of hips that had conversion surgery to THA, and (2) the proportion of hips that underwent repeat fracture surgery after percutaneous screw fixation of stable (Garden Stages I and II) femoral neck fractures in patients older than 65 years and the causes of these reoperations. Methods We performed a retrospective study of all patients older than 65 years with stable femoral neck fractures secondary to low-energy trauma treated surgically at our institution between 2005 and 2008. We identified 121 fractures in 120 patients older than 65 years as stable (Garden Stage I or II); all were treated with percutaneous, cannulated screw fixation in an inverted triangle without performing a capsulotomy or aspiration of the fracture hematoma at the time of surgery. The average age of the patients at the time of fracture was 80 years (range, 65-100 years). Radiographs, operative reports, and medical records were reviewed. Fracture union, nonunion, osteonecrosis, intraarticular hardware, loss of fixation, and conversion to arthroplasty were noted. Followup averaged 11 months (range, 0-5 years) because all patients were included, including those who died. The mortality rate was 40% for all patients at the time of review.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Revision Surgery Occurs Frequently After Percutaneous Fixation of Stable Femoral Neck Fractures in Elderly Patients

Kain

Marcantonio

Iorio

2014

Clin Orthop Relat Res

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“…There is limited evidence that cemented stems are a slightly better choice [72]. For geriatric patients with a femoral neck fracture who are physiologically younger and active, THA reduces reoperation rates and the rate of hip pain reported [39,44,57,58].…”

Section: Operative Fixation Of Fragility Fracturesmentioning

confidence: 99%

Short-term and Long-term Orthopaedic Issues in Patients With Fragility Fractures

Bukata

Kates

O’Keefe

2011

Clinical Orthopaedics &Amp; Related Research

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Background Patients with impaired bone quality who suffer a fragility fracture face substantial challenges in both their short-and long-term care. In addition to poor bone quality, many of these patients have multiple medical comorbidities that alter their surgical risk and affect their ultimate functional recovery. Some medical issues can contribute to the altered bone quality and must be addressed to prevent future fractures. Questions/purposes This review summarizes the modifications in perioperative management and fracture fixation in patients with common fragility fractures who have impaired bone quality. It also summarizes the postoperative diagnosis and treatment of secondary causes of impaired bone quality in these patients. Methods We performed a PubMed search, and literature published after 2000 was prioritized, with the exception of benchmark clinical trial studies published before 2000. Results Patients with altered bone quality require rapid perioperative management of multiple medical comorbidities. Implant selection in patients with poor quality bone should permit early weightbearing, and constructs should maximize surface area contact with the remaining bone. Long-term diagnosis and treatment of other disease states contributing to poor bone quality (vitamin D deficiency/ insufficiency, hypothyroidism, hyperthyroidism, hyperparathyroidism, Cushing's disease, and hypogonadism) must occur to minimize the chances of future fractures. Conclusions Recognition of patients with impaired bone quality and proper treatment of their special needs in both the short and long term are essential for their best opportunity for maximal functional recovery and prevention of future fractures.

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Surgical interventions for treating intracapsular hip fractures in older adults: a network meta-analysis

Lewis

Macey

Stokes

et al. 2022

Cochrane Database of Systematic Reviews

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BackgroundHip fractures are a major healthcare problem, presenting a major challenge and burden to patients and healthcare systems. The number of hip fractures globally is rising rapidly. The majority of intracapsular hip fractures are treated surgically. ObjectivesTo assess the relative effects (benefits and harms) of all surgical treatments used in the management of intracapsular hip fractures in older adults, using a network meta-analysis of randomised trials, and to generate a hierarchy of interventions according to their outcomes. Search methodsWe searched CENTRAL, MEDLINE, Embase, Web of Science, and five other databases in July 2020. We also searched clinical trials databases, conference proceedings, reference lists of retrieved articles and conducted backward-citation searches. Selection criteriaWe included randomised controlled trials (RCTs) and quasi-RCTs comparing different treatments for fragility intracapsular hip fractures in older adults. We included total hip arthoplasties (THAs), hemiarthroplasties (HAs), internal fixation, and non-operative treatments. We excluded studies of patients with specific pathologies other than osteoporosis or resulting from high energy trauma. Data collection and analysisTwo review authors independently assessed studies for inclusion. One review author completed data extraction which was checked by a second. We collected data for three outcomes at different time points: mortality and health-related quality of life (HRQoL) -both reported within 4 months, at 12 months, and after 24 months of surgery, and unplanned return to theatre (at end of study follow-up).We performed a network meta-analysis (NMA) with STATA software, using frequentist methods, and calculated the differences between treatments using risk ratios (RRs) and standardised mean differences (SMDs) and their corresponding 95% confidence intervals (CIs). We also performed direct comparisons using the same codes. Main resultsWe included 119 studies (102 RCTS, 17 quasi-RCTs) with 17,653 participants with 17669 intracapsular fractures in the review; 83% fractures were displaced. The mean participant age ranged from 60 to 87 years and 73% were women.

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Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture

Abstract: These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population.

Cited by 55 publications

References 26 publications

Revision Surgery Occurs Frequently After Percutaneous Fixation of Stable Femoral Neck Fractures in Elderly Patients

Revision Surgery Occurs Frequently After Percutaneous Fixation of Stable Femoral Neck Fractures in Elderly Patients

Short-term and Long-term Orthopaedic Issues in Patients With Fragility Fractures

Surgical interventions for treating intracapsular hip fractures in older adults: a network meta-analysis

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