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Arthroplasty options in femoral-neck fracture: answers from the national registries

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Abstract

Purpose

Femoral-neck fracture in the elderly population is a problem that demands the attention of the orthopaedic community as life expectancy continues to increase. There are several different treatment options in use, and this variety in and of itself indicates the absence of an ideal single treatment option. Recent debate has focussed on the probable superiority of total hip arthroplasty (THA) over hemiarthroplasty for femoral-neck fracture. Clinical trials and systematic reviews of such trials have not provided a convincing answer to this question.

Methods

We analysed data from national registries evaluating prosthetic replacements for femoral-neck fracture in the elderly. We compared revision and reoperation rates of hemiarthroplasty and THA, analysed the prognostic variables that influenced implant survival and the major causes of failure.

Results

Data from the Australian and Italian registries indicate that THA has an increased revision rate compared with bipolar hemiarthroplasty in femoral-neck fracture in the elderly. The registries identify that age over 75 years and the use of the anterior surgical approach are associated with better survivorship in patients who have a hemiarthroplasty. Cemented fixation of the femoral stem in hemiarthroplasty and THA is supported by registry data. Acetabular erosion accounted for a very low percentage of hemiarthroplasty revisions and reoperations.

Conclusion

Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival.

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Acknowledgments

We are grateful to the Australian Orthopaedic Association National Joint Replacement Registry and the Register of the Orthopaedic Prosthetic Implants, Emilia Romagna, Italy, for providing unpublished data on the topic.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Orthopaedics, University of Minnesota, Minneapolis, MN, USA

    Arun Kannan

  2. Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Ramprasad Kancherla, Aditya Soral & Rajesh Malhotra

  3. Malabar Orthopaedic Institute, Monash University, Orthopaedics and The Avenue Hospital, Orthopaedics, Melbourne, Victoria, Australia

    Stephen McMahon

  4. Malabar Orthopaedic Institute, The Avenue Hospital, Orthopaedics, Melbourne, Victoria, Australia

    Gabrielle Hawdon

Authors
  1. Arun Kannan
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  2. Ramprasad Kancherla
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  3. Stephen McMahon
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  4. Gabrielle Hawdon
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  5. Aditya Soral
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  6. Rajesh Malhotra
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Corresponding author

Correspondence to Stephen McMahon.

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Kannan, A., Kancherla, R., McMahon, S. et al. Arthroplasty options in femoral-neck fracture: answers from the national registries. International Orthopaedics (SICOT) 36, 1–8 (2012). https://doi.org/10.1007/s00264-011-1354-z

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  • DOI: https://doi.org/10.1007/s00264-011-1354-z

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