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The different strategies in treating displaced femoral neck fractures : mid-term surgical outcome in a register-based cohort of 1,283 patients aged 60-69 years

Lagergren, Johan LU orcid ; Strøm Rönnquist, Sebastian LU orcid ; Wolf, Olof ; Mukka, Sebastian ; Möller, Michael LU ; Nåtman, Jonatan and Rogmark, Cecilia LU (2023) In Acta Orthopaedica 94. p.505-510
Abstract

BACKGROUND AND PURPOSE: In patients around retirement age controversy exists as to whether to treat displaced femoral neck fracture (dFNF) with internal fixation (IF) or arthroplasty. An arthroplasty in this age group may need revision due to a long expected remaining lifetime. IF carries a higher risk of early failure but a maintained native hip if healing occurs. We aimed to determine the cumulative 5-year rate of conversion to arthroplasty after IF and implant revision after primary total hip arthroplasty (THA), respectively.

PATIENTS AND METHODS: In this longitudinal cohort study, patients aged 60-69 years registered with a dFNF in the Swedish Fracture Register (SFR) 2012-2018 were cross-referenced with available data from the... (More)

BACKGROUND AND PURPOSE: In patients around retirement age controversy exists as to whether to treat displaced femoral neck fracture (dFNF) with internal fixation (IF) or arthroplasty. An arthroplasty in this age group may need revision due to a long expected remaining lifetime. IF carries a higher risk of early failure but a maintained native hip if healing occurs. We aimed to determine the cumulative 5-year rate of conversion to arthroplasty after IF and implant revision after primary total hip arthroplasty (THA), respectively.

PATIENTS AND METHODS: In this longitudinal cohort study, patients aged 60-69 years registered with a dFNF in the Swedish Fracture Register (SFR) 2012-2018 were cross-referenced with available data from the Swedish Arthroplasty Register (SAR) until December 31, 2019. Conversion to arthroplasty or revision were analyzed utilizing competing risk, with death as competing event.

RESULTS: At 5 years, the cumulative rate of conversion to arthroplasty after IF was 31% (95% confidence interval [CI] 26-37). For primary THA, the 5-year rate of revision was 4.0% (CI 2.8-5.8). The 5-year mortality did not differ, being 20% (CI 16-27) and 23% (CI 20-28) after IF and THA, respectively. Regression analyses did not identify any risk factors for conversion arthroplasty based on the variables in the register.

CONCLUSION: A follow-up of 5 years catches most reoperations after IF, resulting in a 31% conversion rate. The 4% revision rate at 5 years after primary THA should be seen as an intermediate result, as late complications may occur.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Longitudinal Studies, Femoral Neck Fractures/epidemiology, Arthroplasty, Replacement, Hip/adverse effects, Reoperation, Treatment Outcome
in
Acta Orthopaedica
volume
94
pages
505 - 510
publisher
Taylor & Francis
external identifiers
  • scopus:85174708174
  • pmid:37830901
ISSN
1745-3682
DOI
10.2340/17453674.2023.20284
language
English
LU publication?
yes
id
f55ecc71-a597-454e-804f-9a67f381f72b
date added to LUP
2023-10-23 18:35:49
date last changed
2024-04-16 10:53:32
@article{f55ecc71-a597-454e-804f-9a67f381f72b,
  abstract     = {{<p>BACKGROUND AND PURPOSE: In patients around retirement age controversy exists as to whether to treat displaced femoral neck fracture (dFNF) with internal fixation (IF) or arthroplasty. An arthroplasty in this age group may need revision due to a long expected remaining lifetime. IF carries a higher risk of early failure but a maintained native hip if healing occurs. We aimed to determine the cumulative 5-year rate of conversion to arthroplasty after IF and implant revision after primary total hip arthroplasty (THA), respectively.</p><p>PATIENTS AND METHODS: In this longitudinal cohort study, patients aged 60-69 years registered with a dFNF in the Swedish Fracture Register (SFR) 2012-2018 were cross-referenced with available data from the Swedish Arthroplasty Register (SAR) until December 31, 2019. Conversion to arthroplasty or revision were analyzed utilizing competing risk, with death as competing event.</p><p>RESULTS: At 5 years, the cumulative rate of conversion to arthroplasty after IF was 31% (95% confidence interval [CI] 26-37). For primary THA, the 5-year rate of revision was 4.0% (CI 2.8-5.8). The 5-year mortality did not differ, being 20% (CI 16-27) and 23% (CI 20-28) after IF and THA, respectively. Regression analyses did not identify any risk factors for conversion arthroplasty based on the variables in the register.</p><p>CONCLUSION: A follow-up of 5 years catches most reoperations after IF, resulting in a 31% conversion rate. The 4% revision rate at 5 years after primary THA should be seen as an intermediate result, as late complications may occur.</p>}},
  author       = {{Lagergren, Johan and Strøm Rönnquist, Sebastian and Wolf, Olof and Mukka, Sebastian and Möller, Michael and Nåtman, Jonatan and Rogmark, Cecilia}},
  issn         = {{1745-3682}},
  keywords     = {{Humans; Longitudinal Studies; Femoral Neck Fractures/epidemiology; Arthroplasty, Replacement, Hip/adverse effects; Reoperation; Treatment Outcome}},
  language     = {{eng}},
  month        = {{10}},
  pages        = {{505--510}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Orthopaedica}},
  title        = {{The different strategies in treating displaced femoral neck fractures : mid-term surgical outcome in a register-based cohort of 1,283 patients aged 60-69 years}},
  url          = {{http://dx.doi.org/10.2340/17453674.2023.20284}},
  doi          = {{10.2340/17453674.2023.20284}},
  volume       = {{94}},
  year         = {{2023}},
}