Dataset Information

Total hip arthroplasty for the management of hip fracture: A review of the literature.

ABSTRACT: Total hip arthroplasty (THA) is indicated for completely displaced femoral neck fractures (FNF) in elderly community ambulators. Compared to open reduction internal fixation (ORIF) and hemiarthroplasty (HA), THA has favorable outcomes in this population. Cementless fixation with prophylactic cabling is the technique of choice. THA is costlier for hip fractures than for osteoarthritis, but is cost effective for FNF given its lower rate of revision than HA or ORIF. Postoperative home discharge with a home exercise program in appropriate patients may effectively control costs while optimizing outcome.

SUBMITTER: Stirton JB

PROVIDER: S-EPMC6403072 | biostudies-literature | 2019 Mar-Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Total hip arthroplasty for the management of hip fracture: A review of the literature.

Stirton Jacob B JB Maier Jacob C JC Nandi Sumon S

Journal of orthopaedics 20190226 2

Total hip arthroplasty (THA) is indicated for completely displaced femoral neck fractures (FNF) in elderly community ambulators. Compared to open reduction internal fixation (ORIF) and hemiarthroplasty (HA), THA has favorable outcomes in this population. Cementless fixation with prophylactic cabling is the technique of choice. THA is costlier for hip fractures than for osteoarthritis, but is cost effective for FNF given its lower rate of revision than HA or ORIF. Postoperative home discharge wit ...[more]

PMID: 30886461

Similar Datasets

Project description:ObjectivesTo determine whether the use of total hip arthroplasty (THA) among individuals with a displaced intracapsular fracture of the femoral neck is based on national guidelines or if there are systematic inequalities.DesignObservational cohort study using the National Hip Fracture Database (NHFD).SettingAll hospitals that treat adults with hip fractures in England, Wales, and Northern Ireland.ParticipantsPatients within the national database (all aged ≥60) who received operative treatment for a non-pathological displaced intracapsular hip fracture from 1 July 2011 to 31 April 2015.Main outcome measuresProvision of THA to patients considered eligible under criteria published by the National Institute for Health and Care Excellence (NICE).Results114 119 patients with hip fracture were included, 11 683 (10.2%) of whom underwent THA. Of those who satisfied the NICE criteria, 32% (6780) : received a THA. Of patients who underwent THA, 42% (4903) did not satisfy the NICE criteria. A recursive partitioning algorithm found that the NICE eligibility criteria did not optimally explain which patients underwent THA. A model with superior explanatory power drew distinctions that are not supported by NICE, which were an age cut off at 76 and a different ambulation cut off. Among patients who satisfied the NICE eligibility, the use of THA was less likely with higher age (odds ratio 0.88, 95% confidence interval 0.87 to 0.88), worsening abbreviated mental test scores (0.49 (0.41 to 0.58) for normal cognition v borderline cognitive impairment)), worsening American Society of Anesthesiologists score (0.74, 0.66 to 0.84), male sex (0.85, 0.77 to 0.93), worsening ambulatory status (0.32, 0.28 to 0.35 for walking with a stick v independent ambulation), and fifths of worsening socioeconomic area deprivation (0.76 (0.66 to 0.88) for least v most deprived fifth). Patients receiving treatment during the working week were more likely to receive THA than at the weekend (0.90, 0.83 to 0.98).ConclusionsThere are wide disparities in the use of THA among individuals with hip fractures, and compliance with NICE guidance is poor. Patients with higher levels of socioeconomic deprivation and those who require surgery at the weekend were less likely to receive THA. Inconsistent compliance with NICE recommendations means that the optimal treatment for older adults with hip fractures can depend on where and when they present to hospital.

Project description:Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056-1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731-0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067-1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.

Dataset Information

Total hip arthroplasty for the management of hip fracture: A review of the literature.

Publications

Total hip arthroplasty for the management of hip fracture: A review of the literature.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets