Long-term risk of reoperation after modular hemiarthroplasty : Any differences between uni- or bipolar design?
(2023) In BMC Musculoskeletal Disorders 24(1).- Abstract
Background: It is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF). Aim: We investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively. Methods: In an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA... (More)
Background: It is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF). Aim: We investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively. Methods: In an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA patients, 12,280 were matched to a UHA control. A subgroup analysis based on the matched sample excluded individuals who died within 5 years and comprised 3,637 individuals with BHA and 3,537 with UHA. Kaplan-Meier survival analysis was used. Results: In the Kaplan-Meier analysis, 92% of the BHA group was free from reoperation at 13 years (95% CI 0.91–0.93), compared to 92% in the UHA group (CI 0.89–0.94). BHA was associated with more reoperations until 3 years. Reoperation due to infection was most common after BHA, n = 212 (1.7%) compared to n = 141 (1.1%) after UHA. Dislocation led to reoperation in 192 of the BHA cases (1.6%) and in 157 of the UHA cases (1.3%). Acetabular erosion/pain occurred in 0.1% and 0.4%. Amongst those surviving ≥ 5 years, 93% of the BHA group was free from reoperation (CI 0.92–0.94) at 13 years, 92% after UHA (CI 0.90–0.94). BHA had more reoperations during the 1st year only. The causes for reoperations showed similar rates except for acetabular erosion/pain. Here the BHA group had 2 cases (0.1%), the UHA had 39 (1.1%). Conclusion: With a modular hemiarthroplasty relatively few patients need a reoperation. During the first years, there is a higher reoperation rate after BHA compared to UHA. Thereafter, no differences are seen. In patients who survive ≥ 5 years after the fracture there are more reoperations due to acetabular erosion after UHA, but crude numbers are extremely low, and the total reoperation rate is not affected.
(Less)
- author
- Lind, Dennis LU ; Nåtman, Jonatan ; Mohaddes, Maziar LU and Rogmark, Cecilia LU
- publishing date
- 2023-12
- type
- Contribution to journal
- publication status
- published
- keywords
- Bipolar, Dislocation, Femoral neck fractures, Hemiarthroplasty, Periprosthetic Infection, Unipolar
- in
- BMC Musculoskeletal Disorders
- volume
- 24
- issue
- 1
- article number
- 911
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:38001417
- scopus:85177772656
- ISSN
- 1471-2474
- DOI
- 10.1186/s12891-023-07035-z
- language
- English
- LU publication?
- no
- additional info
- Publisher Copyright: © 2023, The Author(s).
- id
- d683be75-ffb0-4b26-bfbc-e0f4795e2ac5
- date added to LUP
- 2023-12-20 11:40:54
- date last changed
- 2024-04-18 21:19:19
@article{d683be75-ffb0-4b26-bfbc-e0f4795e2ac5,
abstract = {{<p>Background: It is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF). Aim: We investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively. Methods: In an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA patients, 12,280 were matched to a UHA control. A subgroup analysis based on the matched sample excluded individuals who died within 5 years and comprised 3,637 individuals with BHA and 3,537 with UHA. Kaplan-Meier survival analysis was used. Results: In the Kaplan-Meier analysis, 92% of the BHA group was free from reoperation at 13 years (95% CI 0.91–0.93), compared to 92% in the UHA group (CI 0.89–0.94). BHA was associated with more reoperations until 3 years. Reoperation due to infection was most common after BHA, n = 212 (1.7%) compared to n = 141 (1.1%) after UHA. Dislocation led to reoperation in 192 of the BHA cases (1.6%) and in 157 of the UHA cases (1.3%). Acetabular erosion/pain occurred in 0.1% and 0.4%. Amongst those surviving ≥ 5 years, 93% of the BHA group was free from reoperation (CI 0.92–0.94) at 13 years, 92% after UHA (CI 0.90–0.94). BHA had more reoperations during the 1st year only. The causes for reoperations showed similar rates except for acetabular erosion/pain. Here the BHA group had 2 cases (0.1%), the UHA had 39 (1.1%). Conclusion: With a modular hemiarthroplasty relatively few patients need a reoperation. During the first years, there is a higher reoperation rate after BHA compared to UHA. Thereafter, no differences are seen. In patients who survive ≥ 5 years after the fracture there are more reoperations due to acetabular erosion after UHA, but crude numbers are extremely low, and the total reoperation rate is not affected.</p>}},
author = {{Lind, Dennis and Nåtman, Jonatan and Mohaddes, Maziar and Rogmark, Cecilia}},
issn = {{1471-2474}},
keywords = {{Bipolar; Dislocation; Femoral neck fractures; Hemiarthroplasty; Periprosthetic Infection; Unipolar}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Musculoskeletal Disorders}},
title = {{Long-term risk of reoperation after modular hemiarthroplasty : Any differences between uni- or bipolar design?}},
url = {{http://dx.doi.org/10.1186/s12891-023-07035-z}},
doi = {{10.1186/s12891-023-07035-z}},
volume = {{24}},
year = {{2023}},
}