Bipolar hemiarthroplasty versus total hip arthroplasty in femoral neck fracture patients: results from Lithuanian Arthroplasty Register

Introduction: Elderly patients with displaced femoral neck fractures (FNF) are usually operated with arthroplasty but with various combinations of implants and approaches. Thus, the optimal treatment is still controversial. We aimed to compare the results between the cemented bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) patients operated for FNF regarding revision rate at 1 year postoperatively. Methods: The data were derived from the Lithuanian Arthroplasty Register. We included patients operated with cemented bipolar HA and compared them to the most frequently used cemented THA with 28-mm head during 2011–2016. For survival analysis, we used both revision for all reasons and for dislocations as an endpoint. Cox proportional hazards models were used to analyse the influence of covariates (age groups, gender, surgical approaches and arthroplasty groups). Results: There were 1177 bipolar HA and 514 THA included in our study. 26 (2.2%) revisions had occurred among the bipolar HAs as compared to 25 (4.9%) among the THAs 1 year after surgery. The main reason for revision was dislocation. The unadjusted cumulative revision rate for any reason at 1 year after surgery was 2.4% for the bipolar HA group and 5.1% for the THA group ( p = 0.0054). Cox regression analysis showed that the use of bipolar HA, anterolateral approach and younger age groups had lower risk of revision for all reasons. Conclusion: Bipolar HA and anterolateral approach had a significantly lower overall 1-year risk of revision in femoral neck fracture patients as compared to THA with 28-mm femoral heads.

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Combination of CRP with NLR is a sensitive tool for screening fixation-related infection in patients undergoing conversion total hip arthroplasty after failed internal fixation for femoral neck fracture

The Bone & Joint Journal ◽

10.1302/0301-620x.103b.bjj-2021-0105.r1 ◽

2021 ◽

pp. 1-7

Author(s):

Hong Xu ◽

Jin-Wei Xie ◽

Li Liu ◽

Duan Wang ◽

Ze-Yu Huang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Sensitivity And Specificity ◽

Hip Arthroplasty ◽

Lymphocyte Ratio ◽

Total Hip ◽

Sensitive Tool ◽

Neck Fracture

Aims Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture. Methods We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. Results The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. Conclusion The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients.

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