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Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients.

Rogmark, Cecilia LU and Leonardsson, Olof LU (2016) In The Bone & Joint Journal 98-B(3). p.291-297
Abstract
This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with... (More)
This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases.



TAKE HOME MESSAGE:

There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Bone & Joint Journal
volume
98-B
issue
3
pages
291 - 297
publisher
British Editorial Society of Bone & Joint Surgery
external identifiers
  • pmid:26920951
  • scopus:84960118896
  • wos:000372045500002
ISSN
2049-4408
DOI
10.1302/0301-620X.98B3.36515
language
English
LU publication?
yes
id
1b77c0cc-9054-4264-858b-277b41050ca9 (old id 8821478)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26920951?dopt=Abstract
date added to LUP
2016-03-02 14:51:32
date last changed
2017-11-19 03:48:23
@article{1b77c0cc-9054-4264-858b-277b41050ca9,
  abstract     = {This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases.<br/><br>
<br/><br>
TAKE HOME MESSAGE:<br/><br>
There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group.},
  author       = {Rogmark, Cecilia and Leonardsson, Olof},
  issn         = {2049-4408},
  language     = {eng},
  number       = {3},
  pages        = {291--297},
  publisher    = {British Editorial Society of Bone & Joint Surgery},
  series       = {The Bone & Joint Journal},
  title        = {Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients.},
  url          = {http://dx.doi.org/10.1302/0301-620X.98B3.36515},
  volume       = {98-B},
  year         = {2016},
}