Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease : ANALYSIS OF 9,638 PATIENTS FROM THE SWEDISH HIP ARTHROPLASTY REGISTER
(2022) In Bone and Joint Journal 104-B(1). p.134-141- Abstract
Aims The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005... (More)
Aims The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). Results A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Conclusion Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA.
(Less)
- author
- Cnudde, P. H.J. ; Natman, J. ; Hailer, N. P. and Rogmark, C. LU
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Bone and Joint Journal
- volume
- 104-B
- issue
- 1
- pages
- 8 pages
- publisher
- British Editorial Society of Bone & Joint Surgery
- external identifiers
-
- scopus:85123036707
- pmid:34969279
- ISSN
- 2049-4394
- DOI
- 10.1302/0301-620X.104B1.BJJ-2021-0855.R1
- language
- English
- LU publication?
- yes
- id
- 8b7ecbf1-9e7e-441c-950d-05d5f0d5a480
- date added to LUP
- 2022-03-25 14:53:41
- date last changed
- 2024-07-11 14:12:05
@article{8b7ecbf1-9e7e-441c-950d-05d5f0d5a480,
abstract = {{<p>Aims The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). Results A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Conclusion Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA.</p>}},
author = {{Cnudde, P. H.J. and Natman, J. and Hailer, N. P. and Rogmark, C.}},
issn = {{2049-4394}},
language = {{eng}},
number = {{1}},
pages = {{134--141}},
publisher = {{British Editorial Society of Bone & Joint Surgery}},
series = {{Bone and Joint Journal}},
title = {{Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease : ANALYSIS OF 9,638 PATIENTS FROM THE SWEDISH HIP ARTHROPLASTY REGISTER}},
url = {{http://dx.doi.org/10.1302/0301-620X.104B1.BJJ-2021-0855.R1}},
doi = {{10.1302/0301-620X.104B1.BJJ-2021-0855.R1}},
volume = {{104-B}},
year = {{2022}},
}