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Higher risk of reoperation for bipolar and uncemented hemiarthroplasty 23,509 procedures after femoral neck fractures from the Swedish Hip Arthroplasty Register, 2005-2010

Leonardsson, Olof LU ; Kärrholm, Johan; Åkesson, Kristina LU ; Garellick, Göran and Rogmark, Cecilia LU (2012) In Acta Orthopaedica 83(5). p.459-466
Abstract
Background and purpose Hemiarthroplasty as treatment for femoral neck fractures has increased markedly in Sweden during the last decade. In this prospective observational study, we wanted to identify risk factors for reoperation in modular hemiarthroplasties and to evaluate mortality in this patient group. Patients and methods We assessed 23,509 procedures from the Swedish Hip Arthroplasty Register using the most common surgical approaches with modular uni- or bipolar hemiarthroplasties related to fractures in the period 2005-2010. Completeness of registration (individual procedures) was 89-96%. The median age was 85 years and the median follow-up time was 18 months. Results 3.8% underwent reoperation (any further hip surgery), most often... (More)
Background and purpose Hemiarthroplasty as treatment for femoral neck fractures has increased markedly in Sweden during the last decade. In this prospective observational study, we wanted to identify risk factors for reoperation in modular hemiarthroplasties and to evaluate mortality in this patient group. Patients and methods We assessed 23,509 procedures from the Swedish Hip Arthroplasty Register using the most common surgical approaches with modular uni- or bipolar hemiarthroplasties related to fractures in the period 2005-2010. Completeness of registration (individual procedures) was 89-96%. The median age was 85 years and the median follow-up time was 18 months. Results 3.8% underwent reoperation (any further hip surgery), most often because of implant dislocation or infection. The risk of reoperation (Cox regression) was higher for uncemented stems (hazard ratio (HR) = 1.5), mainly because of periprosthetic femoral fractures. Bipolar implants had a higher risk of reoperation irrespective of cause (HR = 1.3), because of dislocation (1.4), because of infection (1.3), and because of periprosthetic fracture (1.7). The risk of reoperation due to acetabular erosion was lower (0.30) than for unipolar implants, but reoperation for this complication was rare (1.7 per thousand). Procedures resulting from failed internal fixation had a more than doubled risk; the risk was also higher for males and for younger patients. The surgical approach had no influence on the risk of reoperation generally, but the anterolateral transgluteal approach was associated with a lower risk of reoperation due to dislocation (HR = 0.7). At 1 year, the mortality was 24%. Men had a higher risk of death than women (1.8). Interpretation We recommend cemented hemiarthroplasties and the anterolateral transgluteal approach. We also suggest that unipolar implants should be used, at least for the oldest and frailest patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
83
issue
5
pages
459 - 466
publisher
Taylor & Francis
external identifiers
  • wos:000310015700005
  • pmid:22998529
  • scopus:84867845259
ISSN
1745-3682
DOI
10.3109/17453674.2012.727076
language
English
LU publication?
yes
id
5ae9173a-167f-474b-a5e6-c61b4b4320c5 (old id 3123794)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22998529?dopt=Abstract
date added to LUP
2012-10-03 22:28:43
date last changed
2017-11-19 03:57:53
@article{5ae9173a-167f-474b-a5e6-c61b4b4320c5,
  abstract     = {Background and purpose Hemiarthroplasty as treatment for femoral neck fractures has increased markedly in Sweden during the last decade. In this prospective observational study, we wanted to identify risk factors for reoperation in modular hemiarthroplasties and to evaluate mortality in this patient group. Patients and methods We assessed 23,509 procedures from the Swedish Hip Arthroplasty Register using the most common surgical approaches with modular uni- or bipolar hemiarthroplasties related to fractures in the period 2005-2010. Completeness of registration (individual procedures) was 89-96%. The median age was 85 years and the median follow-up time was 18 months. Results 3.8% underwent reoperation (any further hip surgery), most often because of implant dislocation or infection. The risk of reoperation (Cox regression) was higher for uncemented stems (hazard ratio (HR) = 1.5), mainly because of periprosthetic femoral fractures. Bipolar implants had a higher risk of reoperation irrespective of cause (HR = 1.3), because of dislocation (1.4), because of infection (1.3), and because of periprosthetic fracture (1.7). The risk of reoperation due to acetabular erosion was lower (0.30) than for unipolar implants, but reoperation for this complication was rare (1.7 per thousand). Procedures resulting from failed internal fixation had a more than doubled risk; the risk was also higher for males and for younger patients. The surgical approach had no influence on the risk of reoperation generally, but the anterolateral transgluteal approach was associated with a lower risk of reoperation due to dislocation (HR = 0.7). At 1 year, the mortality was 24%. Men had a higher risk of death than women (1.8). Interpretation We recommend cemented hemiarthroplasties and the anterolateral transgluteal approach. We also suggest that unipolar implants should be used, at least for the oldest and frailest patients.},
  author       = {Leonardsson, Olof and Kärrholm, Johan and Åkesson, Kristina and Garellick, Göran and Rogmark, Cecilia},
  issn         = {1745-3682},
  language     = {eng},
  number       = {5},
  pages        = {459--466},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Higher risk of reoperation for bipolar and uncemented hemiarthroplasty 23,509 procedures after femoral neck fractures from the Swedish Hip Arthroplasty Register, 2005-2010},
  url          = {http://dx.doi.org/10.3109/17453674.2012.727076},
  volume       = {83},
  year         = {2012},
}