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Clinical results after hip fracture - with special focus on hip arthroplasty

Hansson, Susanne LU (2018) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2018(134).
Abstract
Hip fractures are of major concern worldwide, but even if literature is
abundant, there are still gaps to fill. The global outcome needs to be better
understood, including patient-reported outcome. Many studies focus on
improving surgical outcome, with less focus on medical complications. The
true number of adverse events after hip fracture surgery is unknown. Femoral
neck fractures (FNFs), constituting half of all hip fractures, are commonly
treated with arthroplasty, but evidence on whether to use hemiarthroplasty
(HA) or total hip arthroplasty (THA) is unclear.

Paper I is a retrospective cohort study of all patients with hip fracture at our
hospital during one year, examining complications and... (More)
Hip fractures are of major concern worldwide, but even if literature is
abundant, there are still gaps to fill. The global outcome needs to be better
understood, including patient-reported outcome. Many studies focus on
improving surgical outcome, with less focus on medical complications. The
true number of adverse events after hip fracture surgery is unknown. Femoral
neck fractures (FNFs), constituting half of all hip fractures, are commonly
treated with arthroplasty, but evidence on whether to use hemiarthroplasty
(HA) or total hip arthroplasty (THA) is unclear.

Paper I is a retrospective cohort study of all patients with hip fracture at our
hospital during one year, examining complications and patient-reported
outcome. Absence of medical and hip complications correlated to improved
satisfaction and pain. Medical complications alone correlated to loss of
function. One-third regained pre-fracture mobility and one-third received
enough rehabilitation.

Paper II is an observational cohort study comparing two matched groups of
patients with THA or HA as treatment for FNF. THA had significantly reduced
risk of revision and reoperation, and was associated with reduced mortality.

Papers III and IV are observational cohort studies on patients treated with THA
or HA for FNF, with adjustment for comorbidity and socioeconomic
background. A majority suffered an adverse event, one-third suffered a
medical complication and one-fifth a hip complication. THA was associated
with fewer medical complications and lower mortality but more hip
complications, even after matching according to comorbidity and
socioeconomic variables.

In conclusion, complications are important for outcome and improving the
overall care of hip fracture patients is as important as the choice of surgical
treatment. THA may perform better than HA in some aspects in selected
patients, but an unbiased comparison between the two types of arthroplasties
is difficult to achieve. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • associate professor Sayed-Noor, Arkan, Umeå University
organization
publishing date
type
Thesis
publication status
published
subject
keywords
hip fracture, femoral neck fracture, arthroplasty, complications, adverse events, patient-reported outcome measures/PROM, rehabilitation
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2018
issue
134
pages
74 pages
publisher
Lund University: Faculty of Medicine
defense location
Lilla aulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö
defense date
2018-11-23 09:00:00
ISSN
1652-8220
ISBN
978-91-7619-702-8
language
English
LU publication?
yes
id
69a9586e-93de-465d-b6ff-095f81d9b4e4
date added to LUP
2018-11-01 22:14:14
date last changed
2019-11-19 13:50:06
@phdthesis{69a9586e-93de-465d-b6ff-095f81d9b4e4,
  abstract     = {Hip fractures are of major concern worldwide, but even if literature is<br/>abundant, there are still gaps to fill. The global outcome needs to be better<br/>understood, including patient-reported outcome. Many studies focus on<br/>improving surgical outcome, with less focus on medical complications. The<br/>true number of adverse events after hip fracture surgery is unknown. Femoral<br/>neck fractures (FNFs), constituting half of all hip fractures, are commonly<br/>treated with arthroplasty, but evidence on whether to use hemiarthroplasty<br/>(HA) or total hip arthroplasty (THA) is unclear.<br/><br/>Paper I is a retrospective cohort study of all patients with hip fracture at our<br/>hospital during one year, examining complications and patient-reported<br/>outcome. Absence of medical and hip complications correlated to improved<br/>satisfaction and pain. Medical complications alone correlated to loss of<br/>function. One-third regained pre-fracture mobility and one-third received<br/>enough rehabilitation.<br/><br/>Paper II is an observational cohort study comparing two matched groups of<br/>patients with THA or HA as treatment for FNF. THA had significantly reduced<br/>risk of revision and reoperation, and was associated with reduced mortality.<br/><br/>Papers III and IV are observational cohort studies on patients treated with THA<br/>or HA for FNF, with adjustment for comorbidity and socioeconomic<br/>background. A majority suffered an adverse event, one-third suffered a<br/>medical complication and one-fifth a hip complication. THA was associated<br/>with fewer medical complications and lower mortality but more hip<br/>complications, even after matching according to comorbidity and<br/>socioeconomic variables.<br/><br/>In conclusion, complications are important for outcome and improving the<br/>overall care of hip fracture patients is as important as the choice of surgical<br/>treatment. THA may perform better than HA in some aspects in selected<br/>patients, but an unbiased comparison between the two types of arthroplasties<br/>is difficult to achieve.},
  author       = {Hansson, Susanne},
  isbn         = {978-91-7619-702-8},
  issn         = {1652-8220},
  language     = {eng},
  number       = {134},
  publisher    = {Lund University: Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Clinical results after hip fracture - with special focus on hip arthroplasty},
  url          = {https://lup.lub.lu.se/search/ws/files/53646589/Avhandling_Susanne_H_tryck_kappan.pdf},
  volume       = {2018},
  year         = {2018},
}