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Dislocation rate, revisions and other complications of primary cemented hemiarthroplasty for displaced femoral neck fractures: a single-center cohort study of 743 unselected hips with a mean 2.7-year follow-up

  • Trauma Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Evidence of whether to use hemiarthroplasty (HA) or total hip arthroplasty for displaced femoral neck fractures (FNF) is still widely debated, especially when taking ambulatory status, age, and patient cognitive status into account. The current study aims to report the rates of dislocations, revisions and other complications for primary cemented HA in patients with displaced FNF.

Materials and methods

Single-center retrospective follow-up study of an unselected historic cohort. 743 consecutive hips (551 W and 192 M) at mean (SD) age of 83.6 (8.4) years received primary cemented HA for displaced FNF by posterolateral surgical approach between January 2012 and December 2019. Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death or end of the follow-up period, and the educational level of the surgeon was noted.

Results

During a mean (SD) follow-up period of 2.7 (2.2) years, there were 6.1% (n = 45) dislocations, in which 82% (first dislocation) appeared within the first 30 postoperative days, and 51% (n = 23) of the dislocations requiring subsequent surgery. At the time of the last available follow-up, 57% (n = 421) of the patients were dead. A non-dislocation related revision was needed in 3.4% (n = 25) of the patients [in which infection accounted for 40% (n = 10) and traumatic periprosthetic fracture for 32% (n = 8)]. Thirty-day mortality was 9.2% and 1-year mortality 25.8%. There were no differences in patient's age, gender, or educational level of the surgeon between the dislocation and the no dislocation groups. Patients aged < 70 years presented with a higher dislocation rate (p < 0.001) than the patients aged > 70 years.

Conclusion

Primary HA presents a safe and robust approach with acceptable complication rates in a genuine unselected cohort of displaced FNF, particularly for patients aged > 70.

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References

  1. Bhandari M, Einhorn TA, Guyatt G et al (2019) Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med 381(23):2199–2208. https://doi.org/10.1056/NEJMoa1906190

    Article  PubMed  Google Scholar 

  2. Boukebous B, Boutroux P, Zahi R, Azmy C, Guillon P (2018) Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: a retrospective case-control study of 199 hips. Orthop Traumatol Surg Res 104(3):369–375. https://doi.org/10.1016/j.otsr.2018.01.006

    Article  CAS  PubMed  Google Scholar 

  3. Burgers PT, Van Geene AR, Van den Bekerom MP et al (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop 36(8):1549–1560. https://doi.org/10.1007/s00264-012-1569-7

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dhanwal DK, Dennison EM, Harvey NC, Cooper C (2011) Epidemiology of hip fracture: worldwide geographic variation. Indian J Orthop 45(1):15–22. https://doi.org/10.4103/0019-5413.73656

    Article  PubMed  PubMed Central  Google Scholar 

  5. DHRR (2016) Danish hip replacement registry—annual report. http://danskhoftealloplastikregister.dk/wp-content/uploads/2015/11/DHR-%C3%A5rsrapport-2016.pdf. Accessed 8 June 2021

  6. DOS (2008) Danish Orthopaedic Society. Reference programme for patients with hip fractures. https://www.ortopaedi.dk/fileadmin/Guidelines/Referenceprogrammer/Referenceprogram_for_patienter_med_hoftebrud2008.pdf. Accessed 8 June 2021

  7. Ekman E, Nurmi H, Reito A, Paloneva J (2019) Complications following 250 cemented modular hip hemiarthroplasties. Scand J Surg 108(4):321–328. https://doi.org/10.1177/1457496918812226

    Article  CAS  PubMed  Google Scholar 

  8. 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(2):211–217. https://doi.org/10.1080/17453670710014996

    Article  PubMed  Google Scholar 

  9. Frihagen F, Nordsletten L, Madsen JE (2007) Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 335(7632):1251–1254. https://doi.org/10.1136/bmj.39399.456551.25

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gao H, Liu Z, Xing D, Gong M (2012) Which is the best alternative for displaced femoral neck fractures in the elderly? A meta-analysis. Clin Orthop Relat Res 470(6):1782–1791. https://doi.org/10.1007/s11999-012-2250-6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg 43(4):647–663

    Article  Google Scholar 

  12. Hernandez NM, Fruth KM, Larson DR, Kremers HM, Sierra RJ (2019) Conversion of hemiarthroplasty to THA carries an increased risk of reoperation compared with primary and revision THA. Clin Orthop Relat Res 477(6):1392–1399. https://doi.org/10.1097/CORR.0000000000000702

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jobory A, Karrholm J, Hansson S, Akesson K, Rogmark C (2021) Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish hip arthroplasty register. Acta Orthop 92(4):413–418. https://doi.org/10.1080/17453674.2021.1906517

    Article  PubMed  PubMed Central  Google Scholar 

  14. Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2005) Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technol Assess 9(41):1–65. https://doi.org/10.3310/hta9410

    Article  Google Scholar 

  15. Kristensen PK, Rock ND, Christensen HC, Pedersen AB (2020) The Danish multidisciplinary hip fracture registry 13-year results from a population-based cohort of hip fracture patients. Clin Epidemiol 12:9–21. https://doi.org/10.2147/CLEP.S231578

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kristensen TB, Dybvik E, Kristoffersen M et al (2020) Cemented or uncemented hemiarthroplasty for femoral neck fracture? Data from the Norwegian hip fracture register. Clin Orthop Relat Res 478(1):90–100. https://doi.org/10.1097/CORR.0000000000000826

    Article  PubMed  Google Scholar 

  17. Leonardsson O, Karrholm J, Akesson K, Garellick G, Rogmark C (2012) Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop 83(5):459–466. https://doi.org/10.3109/17453674.2012.727076

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lewis DP, Waever D, Thorninger R, Donnelly WJ (2019) Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty 34(8):1837–1843. https://doi.org/10.1016/j.arth.2019.03.070

    Article  PubMed  Google Scholar 

  19. Madanat R, Makinen TJ, Ovaska MT, Soiva M, Vahlberg T, Haapala J (2012) Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case-control study. Int Orthop 36(5):935–940. https://doi.org/10.1007/s00264-011-1353-0

    Article  PubMed  Google Scholar 

  20. Migliorini F, Trivellas A, Driessen A et al (2020) Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomized clinical trials. Arch Orthop Trauma Surg 140(11):1695–1704. https://doi.org/10.1007/s00402-020-03409-3

    Article  PubMed  Google Scholar 

  21. Mukka S, Lindqvist J, Peyda S et al (2015) Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: a cohort study. Int Orthop 39(7):1277–1282. https://doi.org/10.1007/s00264-014-2642-1

    Article  PubMed  Google Scholar 

  22. NICE (2011) NICE—National Institute for Health and Care Excellence—Clinical guideline, Hip fracture: management. https://www.nice.org.uk/guidance/cg124. Accessed 8 June 2021

  23. Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 98(3):291–297. https://doi.org/10.1302/0301-620X.98B3.36515

    Article  PubMed  Google Scholar 

  24. Rosengren BE, Bjork J, Cooper C, Abrahamsen B (2017) Recent hip fracture trends in Sweden and Denmark with age-period-cohort effects. Osteoporos Int 28(1):139–149. https://doi.org/10.1007/s00198-016-3768-3

    Article  CAS  PubMed  Google Scholar 

  25. Schmitz PP, van Susante JLC, Somford MP (2019) Low conversion rates toward total hip arthroplasty after hemiarthroplasty in patients under 75 years of age. Eur J Orthop Surg Traumatol 29(8):1687–1691. https://doi.org/10.1007/s00590-019-02498-0

    Article  CAS  PubMed  Google Scholar 

  26. Tabori-Jensen S, Hansen TB, Stilling M (2019) Low dislocation rate of Saturne((R))/Avantage((R)) dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop Trauma Surg 139(5):605–612. https://doi.org/10.1007/s00402-018-3093-8

    Article  PubMed  Google Scholar 

  27. Tol M, van Beers L, Willigenburg NW et al (2021) Posterolateral or direct lateral approach for hemiarthroplasty after femoral neck fractures: a systematic review. Hip Int 31(2):154–165. https://doi.org/10.1177/1120700020931766

    Article  PubMed  Google Scholar 

  28. Vasu BK, Ramamurthi KP, Rajan S, George M (2018) Geriatric patients with hip fracture: frailty and other risk factors affecting the outcome. Anesth Essays Res 12(2):546–551. https://doi.org/10.4103/aer.AER_61_18

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Mats Bue, Stig Storgaard Jakobsen, Jeppe Barckman & Steffan Tábori-Jensen

  2. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark

    Mats Bue, Stig Storgaard Jakobsen, Jeppe Barckman & Steffan Tábori-Jensen

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  1. Mats Bue
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Correspondence to Mats Bue.

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The study was approved by the Danish Patient Safety Authority (registration number 31–1521-407).

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Bue, M., Jakobsen, S.S., Barckman, J. et al. Dislocation rate, revisions and other complications of primary cemented hemiarthroplasty for displaced femoral neck fractures: a single-center cohort study of 743 unselected hips with a mean 2.7-year follow-up. Arch Orthop Trauma Surg 142, 3797–3802 (2022). https://doi.org/10.1007/s00402-021-04252-w

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