International Orthopaedics

, Volume 43, Issue 5, pp 1223–1230 | Cite as

Osteoarthritis is associated with increased failure of proximal femoral fracture fixation

  • Charles A. GallagherEmail author
  • Christopher W. Jones
  • Lara Kimmel
  • Christopher Wylde
  • Anthony Osbrough
  • Max Bulsara
  • Kathryn Hird
  • Piers Yates
Original Paper



The purpose of this study was to evaluate whether the presence of hip osteoarthritis at the time of hip fracture increases treatment failure rates when using either a sliding hip screw (SHS) or proximal femoral nail (PFN) for fracture fixation.


A retrospective study of a consecutive series of 455 women and 148 men (median age, 83.8 years) treated with SHS or PFN was performed. Osteoarthritis was evaluated based on pre-operative radiographs using the Kellgren and Lawrence grading system. Treatment failure, which was defined as non-union, avascular necrosis, backing out of the implant, cut out of the proximal screws, peri-prosthetic fracture, implant breakage, or conversion to hemi- or total hip arthroplasty, was evaluated for a follow-up period of four to seven years. Optimal placement of the implant (tip-apex distance (TAD) and 3-point fixation) and the effects of age, sex, the quality of reduction, implant type, fracture stability, fracture type, and time to failure were considered confounders of the relationship between failure and osteoarthritis (OA).


Among the 32 cases (5.3%) of treatment failure, 12 (2%) showed evidence of osteoarthritis. After controlling for age, sex, the quality of reduction, implant type, fracture stability, fracture type, and TAD, osteoarthritis was associated a greater than threefold increase in treatment failure compared with that of patients without pre-operative evidence of osteoarthritis (OR, 3.26; 95% CI, 1.4–7.65; P = 0.006).


After adjusting for potential confounding factors, radiographic evidence of hip osteoarthritis at the time of hip fracture increases the incidence of treatment failure.


Hip Neck of femur Fracture Osteoarthritis Treatment Failure 



The authors thank Keith Gallagher, TPTC. TSpTC. Dip Gen Studies, and Rosemary Gallagher TPTC. THTC. GDipSpecEd.


The authors declare that there was no financial support for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Formal consent is not required for this type of study.

Informed consent

Informed consent was not required for this study in accordance with the National Health and Medical Research Council (NHMRC) guidelines and Human Research Ethics Committee approval.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsFremantle HospitalFremantleAustralia
  2. 2.Department of PhysiotherapyThe Alfred HospitalMelbourneAustralia
  3. 3.Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
  4. 4.Institute of Health ResearchUniversity of Notre DameFremantleAustralia
  5. 5.School of MedicineUniversity of Notre DameFremantleAustralia

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