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Rate of conversion to secondary arthroplasty after femoral neck fractures in 796 younger patients treated with internal fixation: a Swedish national register-based study

Strøm Rönnquist, Sebastian LU orcid ; Lagergren, Johan LU orcid ; Viberg, Bjarke ; Möller, Michael LU and Rogmark, Cecilia LU (2022) In Acta Orthopaedica 93. p.547-553
Abstract
Background and purpose: In younger patients with a femoral neck fracture (FNF), internal fixation is the recommended treatment regardless of displacement. Healing complications are often treated with arthroplasty. We determined the rate of conversion to arthroplasty up to 5 years after fixation of either undisplaced FNFs (uFNFs) or displaced FNFs (dFNFs).
Patients and methods: The study was based on prospectively collected data from the Swedish Fracture Register (SFR) and the Swedish Arthroplasty Register (SAR). FNFs in patients aged < 60 treated with parallel pins/screws or sliding hip screws (SHS) registered in SFR 2012–2018 were cross-referenced with conversions to arthroplasty registered in SAR until 2019. The cumulative... (More)
Background and purpose: In younger patients with a femoral neck fracture (FNF), internal fixation is the recommended treatment regardless of displacement. Healing complications are often treated with arthroplasty. We determined the rate of conversion to arthroplasty up to 5 years after fixation of either undisplaced FNFs (uFNFs) or displaced FNFs (dFNFs).
Patients and methods: The study was based on prospectively collected data from the Swedish Fracture Register (SFR) and the Swedish Arthroplasty Register (SAR). FNFs in patients aged < 60 treated with parallel pins/screws or sliding hip screws (SHS) registered in SFR 2012–2018 were cross-referenced with conversions to arthroplasty registered in SAR until 2019. The cumulative conversion and mortality rates were determined by Kaplan–Meier analyses and patient- and surgery-dependent risk factors for conversion by Cox regression analyses.
Results: We included 407 uFNFs and 389 dFNFs (median age 52, 59% men). The 1-year conversion rate was 3% (95% CI 1–5) for uFNFs and 9% (CI 6–12) for dFNFs. Corresponding results at 5 years were 8% (CI 5–11) and 25% (CI 20–30). Besides a displaced fracture, age 50–59 was associated with an increased rate of conversion in uFNFs. This older group also had a higher mortality rate, compared with patients aged < 50. There was no sex difference for mortality.
Interpretation: Adults aged under 60 with uFNFs and dFNFs face an 8–25% risk, respectively, of conversion to arthroplasty within 5 years after internal fixation. This is new and pertinent information for surgeons as well as patients. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
93
pages
547 - 553
publisher
Taylor & Francis
external identifiers
  • pmid:35700048
  • scopus:85132079052
ISSN
1745-3682
DOI
10.2340/17453674.2022.3038
project
Hip fracture in adults under 60 years of age. A prospective multi-center study of the epidemiology, treatment, outcome and patient satisfaction regarding hip fractures.
language
English
LU publication?
yes
id
69a4f971-13fb-44c0-912d-cebb0a33cf7e
date added to LUP
2022-08-17 13:25:25
date last changed
2025-10-19 01:52:21
@article{69a4f971-13fb-44c0-912d-cebb0a33cf7e,
  abstract     = {{Background and purpose: In younger patients with a femoral neck fracture (FNF), internal fixation is the recommended treatment regardless of displacement. Healing complications are often treated with arthroplasty. We determined the rate of conversion to arthroplasty up to 5 years after fixation of either undisplaced FNFs (uFNFs) or displaced FNFs (dFNFs).<br/>Patients and methods: The study was based on prospectively collected data from the Swedish Fracture Register (SFR) and the Swedish Arthroplasty Register (SAR). FNFs in patients aged &lt; 60 treated with parallel pins/screws or sliding hip screws (SHS) registered in SFR 2012–2018 were cross-referenced with conversions to arthroplasty registered in SAR until 2019. The cumulative conversion and mortality rates were determined by Kaplan–Meier analyses and patient- and surgery-dependent risk factors for conversion by Cox regression analyses.<br/>Results: We included 407 uFNFs and 389 dFNFs (median age 52, 59% men). The 1-year conversion rate was 3% (95% CI 1–5) for uFNFs and 9% (CI 6–12) for dFNFs. Corresponding results at 5 years were 8% (CI 5–11) and 25% (CI 20–30). Besides a displaced fracture, age 50–59 was associated with an increased rate of conversion in uFNFs. This older group also had a higher mortality rate, compared with patients aged &lt; 50. There was no sex difference for mortality.<br/>Interpretation: Adults aged under 60 with uFNFs and dFNFs face an 8–25% risk, respectively, of conversion to arthroplasty within 5 years after internal fixation. This is new and pertinent information for surgeons as well as patients.}},
  author       = {{Strøm Rönnquist, Sebastian and Lagergren, Johan and Viberg, Bjarke and Möller, Michael and Rogmark, Cecilia}},
  issn         = {{1745-3682}},
  language     = {{eng}},
  month        = {{06}},
  pages        = {{547--553}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Orthopaedica}},
  title        = {{Rate of conversion to secondary arthroplasty after femoral neck fractures in 796 younger patients treated with internal fixation: a Swedish national register-based study}},
  url          = {{http://dx.doi.org/10.2340/17453674.2022.3038}},
  doi          = {{10.2340/17453674.2022.3038}},
  volume       = {{93}},
  year         = {{2022}},
}