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The association of surgical approach and bearing size and type with dislocation in total hip arthroplasty for acute hip fracture

Rogmark, Cecilia LU ; Nåtman, Jonatan ; Jobory, Ammar LU ; Hailer, Nils P. and Cnudde, Peter (2022) In The Bone & Joint Journal 104-B(7). p.844-851
Abstract

AIMS: Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied. METHODS: In an observational cohort study on 8,031 FNF patients with THA between January 2005 and December 2014, Swedish Arthroplasty Register data were linked with the National Patient Register, recording the total dislocation rates at one year and revision rates at three years after surgery. The cumulative incidence of events was estimated using the... (More)

AIMS: Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied. METHODS: In an observational cohort study on 8,031 FNF patients with THA between January 2005 and December 2014, Swedish Arthroplasty Register data were linked with the National Patient Register, recording the total dislocation rates at one year and revision rates at three years after surgery. The cumulative incidence of events was estimated using the Kaplan-Meier method. Cox multivariable regression models were fitted to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of dislocation, revision, or mortality, stratified by surgical approach. RESULTS: The cumulative dislocation rate at one year was 8.3% (95% CI 7.3 to 9.3) for patients operated on using the posterior approach and 2.7% (95% CI 2.2 to 3.2) when using the direct lateral approach. In the posterior approach group, use of DMC was associated with reduced adjusted risk of dislocation compared to 32 mm heads (HR 0.21 (95% CI 0.07 to 0.68); p = 0.009). This risk was increased with head sizes < 32 mm (HR 1.47 (95% CI 1.10 to 1.98); p = 0.010). Neither DMC nor different head sizes influenced the risk of revision following the posterior approach. Neither articulation was associated with a statistically significantly reduced adjusted risk of dislocation in patients where the direct lateral approach was performed, although this risk was estimated to be HR 0.14 (95% CI 0.02 to 1.02; p = 0.053) after the use of DMC. DMC inserted through a direct lateral approach was associated with a reduced risk of revision for any reason versus THA with 32 mm heads (HR 0.36 (95% CI 0.13 to 0.99); p = 0.047). CONCLUSION: When using a posterior approach for THA in FNF patients, DMC reduces the risk of dislocation, while a non-significant risk reduction is seen for DMC after use of the direct lateral approach. The direct lateral approach is protective against dislocation and is also associated with a lower rate of revision at three years, compared to the posterior approach. Cite this article: Bone Joint J 2022;104-B(7):844-851.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute hip fracture, Arthroplasty, Arthroplasty Register, cohort studies, Comorbidities, Dislocation, Dual mobility component, dual-mobility components, Femoral neck fracture, femoral neck fractures, Hip fracture, Kaplan-Meier method, posterior approaches, Surgical approach, surgical approaches, Total hip arthroplasty (THA)
in
The Bone & Joint Journal
volume
104-B
issue
7
pages
8 pages
publisher
British Editorial Society of Bone & Joint Surgery
external identifiers
  • scopus:85133243136
  • pmid:35775180
ISSN
2049-4408
DOI
10.1302/0301-620X.104B7.BJJ-2021-1772.R1
language
English
LU publication?
yes
id
075b1c34-0559-44c8-9fc0-48eb1dea581c
date added to LUP
2022-09-08 12:37:49
date last changed
2024-12-10 04:50:49
@article{075b1c34-0559-44c8-9fc0-48eb1dea581c,
  abstract     = {{<p>AIMS: Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied. METHODS: In an observational cohort study on 8,031 FNF patients with THA between January 2005 and December 2014, Swedish Arthroplasty Register data were linked with the National Patient Register, recording the total dislocation rates at one year and revision rates at three years after surgery. The cumulative incidence of events was estimated using the Kaplan-Meier method. Cox multivariable regression models were fitted to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of dislocation, revision, or mortality, stratified by surgical approach. RESULTS: The cumulative dislocation rate at one year was 8.3% (95% CI 7.3 to 9.3) for patients operated on using the posterior approach and 2.7% (95% CI 2.2 to 3.2) when using the direct lateral approach. In the posterior approach group, use of DMC was associated with reduced adjusted risk of dislocation compared to 32 mm heads (HR 0.21 (95% CI 0.07 to 0.68); p = 0.009). This risk was increased with head sizes &lt; 32 mm (HR 1.47 (95% CI 1.10 to 1.98); p = 0.010). Neither DMC nor different head sizes influenced the risk of revision following the posterior approach. Neither articulation was associated with a statistically significantly reduced adjusted risk of dislocation in patients where the direct lateral approach was performed, although this risk was estimated to be HR 0.14 (95% CI 0.02 to 1.02; p = 0.053) after the use of DMC. DMC inserted through a direct lateral approach was associated with a reduced risk of revision for any reason versus THA with 32 mm heads (HR 0.36 (95% CI 0.13 to 0.99); p = 0.047). CONCLUSION: When using a posterior approach for THA in FNF patients, DMC reduces the risk of dislocation, while a non-significant risk reduction is seen for DMC after use of the direct lateral approach. The direct lateral approach is protective against dislocation and is also associated with a lower rate of revision at three years, compared to the posterior approach. Cite this article: Bone Joint J 2022;104-B(7):844-851.</p>}},
  author       = {{Rogmark, Cecilia and Nåtman, Jonatan and Jobory, Ammar and Hailer, Nils P. and Cnudde, Peter}},
  issn         = {{2049-4408}},
  keywords     = {{acute hip fracture; Arthroplasty; Arthroplasty Register; cohort studies; Comorbidities; Dislocation; Dual mobility component; dual-mobility components; Femoral neck fracture; femoral neck fractures; Hip fracture; Kaplan-Meier method; posterior approaches; Surgical approach; surgical approaches; Total hip arthroplasty (THA)}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{7}},
  pages        = {{844--851}},
  publisher    = {{British Editorial Society of Bone & Joint Surgery}},
  series       = {{The Bone & Joint Journal}},
  title        = {{The association of surgical approach and bearing size and type with dislocation in total hip arthroplasty for acute hip fracture}},
  url          = {{http://dx.doi.org/10.1302/0301-620X.104B7.BJJ-2021-1772.R1}},
  doi          = {{10.1302/0301-620X.104B7.BJJ-2021-1772.R1}},
  volume       = {{104-B}},
  year         = {{2022}},
}