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Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients.

Rogmark, Cecilia LU ; Fenstad, Anne M; Leonardsson, Olof LU ; Engesæter, Lars B; Kärrholm, Johan; Furnes, Ove; Garellick, Göran and Gjertsen, Jan-Erik (2014) In Acta Orthopaedica 85(1). p.18-25
Abstract
Background Hemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden. Material and methods A common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals > 60 years of age treated with modular hemiarthroplasties were reported for the period 2005-2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume). Results 1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7... (More)
Background Hemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden. Material and methods A common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals > 60 years of age treated with modular hemiarthroplasties were reported for the period 2005-2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume). Results 1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7 (SD 1.7) years. In patients over 85 years, an increased risk of reoperation was found for uncemented stems (HR = 2.2, 95% CI: 1.7-2.8), bipolar heads (HR = 1.4, CI: 1.2-1.8), posterior approach (HR = 1.4, CI: 1.2-1.8) and male sex (HR = 1.3, CI: 1.0-1.6). For patients aged 75-85 years, uncemented stems (HR = 1.6, 95% CI: 1.2-2.0) and men (HR = 1.3, CI: 1.1-1.6) carried an increased risk. Increased risk of reoperation due to infection was found for patients aged < 75 years (HR = 1.5, CI: 1.1-2.0) and for uncemented stems. For open surgery due to dislocation, the strongest risk factor was a posterior approach (HR = 2.2, CI: 1.8-2.6). Uncemented stems in particular (HR = 3.6, CI: 2.4-5.3) and male sex increased the risk of periprosthetic fracture surgery. Interpretation Cemented stems and a direct lateral transgluteal approach reduced the risk of reoperation after hip fractures treated with hemiarthroplasty in patients over 75 years. Men and younger patients had a higher risk of reoperation. For the age group 60-74 years, there were no such differences in risk in this material. (Less)
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type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
85
issue
1
pages
18 - 25
publisher
Taylor & Francis
external identifiers
  • pmid:24460108
  • wos:000332206100006
  • scopus:84896859972
ISSN
1745-3682
DOI
10.3109/17453674.2014.885356
language
English
LU publication?
yes
id
f8d120f6-fdcf-4a38-86d1-916c794f39b0 (old id 4290726)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24460108?dopt=Abstract
date added to LUP
2014-02-07 14:04:06
date last changed
2017-11-19 03:04:04
@article{f8d120f6-fdcf-4a38-86d1-916c794f39b0,
  abstract     = {Background Hemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden. Material and methods A common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals &gt; 60 years of age treated with modular hemiarthroplasties were reported for the period 2005-2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume). Results 1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7 (SD 1.7) years. In patients over 85 years, an increased risk of reoperation was found for uncemented stems (HR = 2.2, 95% CI: 1.7-2.8), bipolar heads (HR = 1.4, CI: 1.2-1.8), posterior approach (HR = 1.4, CI: 1.2-1.8) and male sex (HR = 1.3, CI: 1.0-1.6). For patients aged 75-85 years, uncemented stems (HR = 1.6, 95% CI: 1.2-2.0) and men (HR = 1.3, CI: 1.1-1.6) carried an increased risk. Increased risk of reoperation due to infection was found for patients aged &lt; 75 years (HR = 1.5, CI: 1.1-2.0) and for uncemented stems. For open surgery due to dislocation, the strongest risk factor was a posterior approach (HR = 2.2, CI: 1.8-2.6). Uncemented stems in particular (HR = 3.6, CI: 2.4-5.3) and male sex increased the risk of periprosthetic fracture surgery. Interpretation Cemented stems and a direct lateral transgluteal approach reduced the risk of reoperation after hip fractures treated with hemiarthroplasty in patients over 75 years. Men and younger patients had a higher risk of reoperation. For the age group 60-74 years, there were no such differences in risk in this material.},
  author       = {Rogmark, Cecilia and Fenstad, Anne M and Leonardsson, Olof and Engesæter, Lars B and Kärrholm, Johan and Furnes, Ove and Garellick, Göran and Gjertsen, Jan-Erik},
  issn         = {1745-3682},
  language     = {eng},
  number       = {1},
  pages        = {18--25},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients.},
  url          = {http://dx.doi.org/10.3109/17453674.2014.885356},
  volume       = {85},
  year         = {2014},
}