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Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 2, pp 255–261 | Cite as

Does surgeon volume influence the outcome after hip hemiarthroplasty for displaced femoral neck fractures; early outcome, complications, and survival of 752 cases

  • Elsa A. SpaansEmail author
  • Koen L. M. Koenraadt
  • Robert Wagenmakers
  • Leon H. G. J. Elmans
  • Joost A. A. M. van den Hout
  • D. Eygendaal
  • Stefan B. T. Bolder
Hip Arthroplasty
  • 56 Downloads

Abstract

Introduction

Surgeon volume of hip arthroplasties is of importance with regard to complication and revision rates in total hip arthroplasty. For hip hemiarthroplasty, the effect of surgeon volume on outcome is far less studied. We analyzed the outcome of hip hemiarthroplasties performed by orthopedic surgeons in a retrospective cohort in different volume categories, focusing on early survival of the prosthesis and complications.

Methods

Between March 2009 and January 2014, 752 hemiarthroplasties were performed for intracapsular femoral neck fracture by 27 orthopedic surgeons in a large Dutch teaching hospital. Surgeons were divided into four groups, a resident group and three groups based on the number of total hip arthroplasties and hemiarthroplasties performed per year: a low-volume (< 10 arthroplasties per year), moderate-volume (10–35 arthroplasties per year), and high-volume groups (> 35 arthroplasties per year). Outcome measures were stem survival using a competing risk analysis, complication rates, and mortality. Chi-square tests were used to compare complication rates and mortality between groups.

Results

Patients were followed for a minimum of 2 years or until revision or death. Overall 60% of the patients included had died at time of follow-up. We found comparable stem survival rates in the low-volume group (n = 48), moderate-volume group (n = 201), high-volume group (n = 446), and resident group (n = 57). There were no significant differences between the groups with regard to dislocation rate, incidence of periprosthetic fracture, infection, and mortality.

Conclusion

Surgeon volume and experience did not influence early outcome and complication rates in hip hemiarthroplasty. Hemiarthroplasty can safely be performed by both experienced hip surgeons and low-volume surgeons.

Keywords

Hip hemiarthroplasty Femoral neck fractures Surgical volume Survival Complications 

Notes

Funding

Our research foundation (FORCE) receives money from Zimmer-Biomet, Stryker and Mathys not directly related to this study. Two authors are consultant for Stryker and one author is consultant for A.O., Stryker and Advisory Board for Lima Corporates.

References

  1. 1.
    Stevens JA, Rudd RA (2013) The impact of decreasing US hip fracture rates on future hip fracture estimates. Osteoporos Int 24:2725–2728.  https://doi.org/10.1007/s00198-013-2375-9 CrossRefGoogle Scholar
  2. 2.
    Concin H, Brozek W, Benedetto K-P et al (2016) Hip fracture incidence 2003–2013 and projected cases until 2050 in Austria: a population-based study. Int J Public Health.  https://doi.org/10.1007/s00038-016-0878-9 Google Scholar
  3. 3.
    Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Jt J 98–B:291–297.  https://doi.org/10.1302/0301-620X.98B3.36515 CrossRefGoogle Scholar
  4. 4.
    Birkmeyer JD, Stukel TA, Siewers AE et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127.  https://doi.org/10.1056/NEJMsa035205 CrossRefGoogle Scholar
  5. 5.
    Chowdhury MM, Dagash H, Pierro A (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 94:145–161.  https://doi.org/10.1002/bjs.5714 CrossRefGoogle Scholar
  6. 6.
    Critchley RJ, Baker PN, Deehan DJ (2012) Does surgical volume affect outcome after primary and revision knee arthroplasty? A systematic review of the literature. Knee 19:513–518.  https://doi.org/10.1016/j.knee.2011.11.007 CrossRefGoogle Scholar
  7. 7.
    Doro C, Dimick J, Wainess R et al (2006) Hospital volume and inpatient mortality outcomes of total hip arthroplasty in the United States. J Arthroplasty 21:10–16.  https://doi.org/10.1016/j.arth.2006.05.009 CrossRefGoogle Scholar
  8. 8.
    Sharkey PF, Shastri S, Teloken MA et al (2004) Relationship between surgical volume and early outcomes of total hip arthroplasty. Do results continue to get better? J Arthroplasty 19:694–699.  https://doi.org/10.1016/j.arth.2004.02.040 CrossRefGoogle Scholar
  9. 9.
    Manley M, Ong K, Lau E, Kurtz SM (2008) Effect of volume on total hip arthroplasty revision rates in the United States medicare population. J Bone Jt Surg Am 90:2446–2451.  https://doi.org/10.2106/JBJS.G.01300 CrossRefGoogle Scholar
  10. 10.
    Ravi B, Jenkinson R, Austin PC et al (2014) Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ 348:g3284.  https://doi.org/10.1136/bmj.g3284 CrossRefGoogle Scholar
  11. 11.
    Khunda A, Jafari M, Alazzawi S et al (2013) Mortality and re-operation rate after proximal femoral fracture surgery by trainees. J Orthop Surg (Hong Kong) 21:87–91CrossRefGoogle Scholar
  12. 12.
    Palm H, Jacobsen S, Krasheninnikoff M et al (2007) Influence of surgeon’s experience and supervision on re-operation rate after hip fracture surgery. Injury 38:775–779.  https://doi.org/10.1016/j.injury.2006.07.043 CrossRefGoogle Scholar
  13. 13.
    Shah SN, Wainess RM, Karunakar MA (2005) Hemiarthroplasty for femoral neck fracture in the elderly: surgeon and hospital volume-related outcomes. J Arthroplasty 20:503–508.  https://doi.org/10.1016/j.arth.2004.03.025 CrossRefGoogle Scholar
  14. 14.
    Lavernia CJ (1998) Hemiarthroplasty in hip fracture care: effects of surgical volume on short-term outcome. J Arthroplasty 13:774–778CrossRefGoogle Scholar
  15. 15.
    Ames JB, Lurie JD, Tomek IM et al (2010) Does surgeon volume for total hip arthroplasty affect outcomes after hemiarthroplasty for femoral neck fracture? Am J Orthop 39(8):E84–E89Google Scholar
  16. 16.
    Scrucca L, Santucci A, Aversa F (2007) Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transplant 381–387.  https://doi.org/10.1038/sj.bmt.1705727
  17. 17.
    Brooks PJ (2013) Dislocation following total hip replacement: causes and cures. Bone Jt J 95:67–69.  https://doi.org/10.1302/0301-620X.95B11.32645 CrossRefGoogle Scholar
  18. 18.
    Enocson A, Tidermark J, Tornkvist H, Lapidus LJ (2008) Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop 79:211–217.  https://doi.org/10.1080/17453670710014996 CrossRefGoogle Scholar
  19. 19.
    White RE, Forness TJ, Allman JK, Junick DW (2001) Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res 393:163–167.  https://doi.org/10.1097/00003086-200112000-00019 CrossRefGoogle Scholar
  20. 20.
    Jong L de, Klem TMAL, Kuijper TM, Roukema GR (2017) Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Jt J 99–B:1088–1094.  https://doi.org/10.1302/0301-620X.99B8.BJJ-2016-1119.R1 CrossRefGoogle Scholar
  21. 21.
    Noailles T, Brulefert K, Chalopin A, Longis PM (2016) What are the risk factors for post-operative infection after hip hemiarthroplasty ? Systematic review of literature. Int Orthop 1843–1848.  https://doi.org/10.1007/s00264-015-3033-y
  22. 22.
    Enocson A, Hedbeck CJ, Törnkvist H et al (2012) Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop 36:711–717.  https://doi.org/10.1007/s00264-011-1326-3 CrossRefGoogle Scholar
  23. 23.
    Langslet E, Frihagen F, Opland V (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res 472:1291–1299.  https://doi.org/10.1007/s11999-013-3308-9 CrossRefGoogle Scholar
  24. 24.
    Carli AV, Negus JJ, Haddad FS (2017) Periprosthetic femoral fractures and trying to avoid them; what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Jt J 99B:50–59.  https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0220.R1 CrossRefGoogle Scholar
  25. 25.
    Reidy M, Faulkner A, Shitole B, Clift B (2016) Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty? A ten year review. Bone Jt J 98–B:301–306.  https://doi.org/10.1302/0301-620X.98B3.35997 CrossRefGoogle Scholar
  26. 26.
    Hedlundh U, Ahnfelt L, Hybbinette C-H et al (1996) Surgical experience related to dislocations after total hip arthroplasty. J Bone Jt Surg 78–B:206–209CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Elsa A. Spaans
    • 1
    Email author
  • Koen L. M. Koenraadt
    • 2
  • Robert Wagenmakers
    • 1
  • Leon H. G. J. Elmans
    • 1
  • Joost A. A. M. van den Hout
    • 1
  • D. Eygendaal
    • 1
    • 3
  • Stefan B. T. Bolder
    • 1
  1. 1.Department of Orthopedic SurgeryAmphia Hospital BredaBredaThe Netherlands
  2. 2.Foundation for Orthopedic Research, Care and EducationAmphia Hospital BredaBredaThe Netherlands
  3. 3.Department of Orthopedic Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

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