Total hip replacement for neck of femur fracture: Comparing outcomes with matched elective cohort

Lim, Jun Wei; Ng, Guat Shi; Jenkins, R.C.; Ridley, David; Jariwala, Arpit; Sripada, S.

doi:10.1016/j.injury.2016.07.019

Cited by 22 publications

(11 citation statements)

References 35 publications

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“…In the RCT by the HEALTH investigators, the incidence of periprosthetic fracture within two years of hip fracture surgery was 5.3% for THA and 4.8% for hemiarthroplasty [ 8 ]. The rate of periprosthetic fracture reported in the present study is comparable to that reported for elective primary THA [ 18 , 25 ]. Meek et al reported a periprosthetic fracture incidence of 0.9% five years post-primary elective THA in a registry study of over 50,000 THAs [ 26 ].…”

Section: Discussionsupporting

confidence: 85%

“…The rate of dislocation in this study is similar or less than published rates of dislocation for conventional THA for hip fracture [ 9 , 12 , 18 ]. In a meta-analysis comparing THA to hemiarthroplasty for hip fracture, Lewis et al reported a dislocation rate of 8.1% in 591 THA compared to 2.7% in 630 hemiarthroplasties with varying durations of follow-up [ 4 ].…”

Section: Discussionsupporting

confidence: 77%

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Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship

Gill¹,

Pathan²,

Parsons³

et al. 2021

Cureus

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The purpose of this study is to report the clinical results and mid-term survivorship for total hip arthroplasty (THA) performed to treat displaced intracapsular hip fracture. MethodsBetween January 2005 and December 2019, 414 patients underwent THA for acute displaced intracapsular hip fracture. The mean age of patients was 73.2±8.0. Out of the total patients, 89.6% received a cemented THA. Kaplan-Meier analysis was performed with implant survivorship and dislocation as separate endpoints. Complications and modified Harris Hip Score (HHS) at the latest follow-up were also reported. ResultsThere was a total of nine revisions, six were performed for dislocation and three for infection. Kaplan-Meier implant survivorship was 99.0% at five years and 97.7% at ten years. Twenty (4.8%) patients suffered at least one dislocation and 11 suffered more than one, so following a first dislocation, the chance of one or more further dislocations was 11/20 (55%). Kaplan-Meier analysis with dislocation as the endpoint showed the risk of dislocation of 2.9, 4.4, and 5.2% at one, five, and ten years respectively. Three (0.7%) patients suffered late periprosthetic fractures and 22 (5.3%) contralateral hip fractures. The mean modified HHS at the latest follow-up was 86.3±18.9. ConclusionIn conclusion, the present study shows excellent implant survivorship, good hip function, and moderate risk of dislocation and contralateral hip fracture following THA for displaced intracapsular hip fracture. Our study shows favourable results for THA treatment in a selected group of patients with hip fractures.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 77%

Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship

Gill¹,

Pathan²,

Parsons³

et al. 2021

Cureus

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“…In literature, good results with DMC implants were reported in either FNF [ 20 , 21 , 22 ] or other conditions at increased risk for dislocation [ 10 ]. However, there are few retrospective and some register studies comparing DMC THA and standard THA in FNF [ 17 , 23 , 24 , 25 ], despite it being known that THA for fractures has a higher risk of dislocation than THA for osteoarthritis [ 26 , 27 , 28 ]. This risk could be related to different predisposing conditions observed in FNF patients, such as a good preoperative hip ROM, the prevalence of recurrent falls in older patients or the frequent postoperative delirium that compromises adherence to rehabilitation programs [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants

Alberio¹,

Rusconi

Martinetti

et al. 2021

Geriatrics

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The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.

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“…The comparison of hospital results based on Ŝ i (t) presented in the previous section does not account for systematic differences between groups of patients across hospitals, which may be necessary for some of the considered types of implantations. For hip replacements, for instance, readmission rates are known to be lower for elective operations compared to implantations for the treatment of femoral fractures (Lim et al 2016). Thus, hospital results should be compared under consideration of their respective patient population (Iezzoni 2013).…”

Section: Estimating Hospital-specific Effects On the Hazard Functionmentioning

confidence: 99%

Evaluating quality of hospital care using time-to-event endpoints based on patient follow-up data

Hengelbrock

Höhle

2019

Health Serv Outcomes Res Method

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Revisions of hip and knee arthroplasty implants and cardiac pacemakers pose a large medical and economic burden for society. Consequently, the identification of health care providers with potential for quality improvements regarding the reduction of revision rates is a central aim of quality assurance in any healthcare system. Even though the time span between initial and possible subsequent operations is a classical time-to-event endpoint, hospital-specific quality indicators are in practice often measured as revisions within a fixed follow-up period and subsequently analyzed by traditional methods like proportions or logistic regression. Methods from survival analysis, in contrast, allow the inclusion of all observations, i.e. also those with early censoring or events, and make thus more efficient and more timely use of the available data than traditional methods. This may be obvious to a statistician but in an applied context with historic traditions, the introduction of more complicated methods needs a clear presentation of their added value. We demonstrate how standard survival methods like the Kaplan-Meier estimator and a multiplicative hazards model outperform traditional methods with regard to the identification of performance outliers. Following that, we use the proposed methods to analyze 640,000 hip and knee replacement operations with about 13,000 revisions between 2015 and 2016 in more than 1200 German hospitals in the annual evaluation of quality of care. Based on the results, performance outliers are identified which are to be further investigated qualitatively with regard to their provided quality of care and possible necessary measures for improvement. Survival analysis is a sound statistical framework for analyzing data in the context of quality assurance and survival methods outperform the statistical methods that are traditionally used in this area.

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Total hip replacement for neck of femur fracture: Comparing outcomes with matched elective cohort

Abstract: Introduction: Current literature suggests that total hip replacement (THR) is

Cited by 22 publications

References 35 publications

Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship

Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship

Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants

Evaluating quality of hospital care using time-to-event endpoints based on patient follow-up data

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