Practice variation in total hip arthroplasty versus hemiarthroplasty for treatment of fractured neck of femur in Australia

2019 ◽  
Vol 101-B (1) ◽  
pp. 92-95 ◽  
Author(s):  
I. A. Harris ◽  
A. Cuthbert ◽  
R. de Steiger ◽  
P. Lewis ◽  
S. E. Graves
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Practice Variation ◽  
Public Hospitals ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Relative Indication ◽  
Day Of The Week

Aims Displaced femoral neck fractures (FNF) may be treated with partial (hemiarthroplasty, HA) or total hip arthroplasty (THA), with recent recommendations advising that THA be used in community-ambulant patients. This study aims to determine the association between the proportion of FNF treated with THA and year of surgery, day of the week, surgeon practice, and private versus public hospitals, adjusting for known confounders. Patients and Methods Data from 67 620 patients in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1999 to 2016 inclusive were used to generate unadjusted and adjusted analyses of the associations between patient, time, surgeon and institution factors, and the proportion of FNF treated with THA. Results Overall, THA was used in 23.7% of patients. THA was more frequently used over time, in younger patients, in healthier patients, in cases performed on weekdays (adjusted odds ratio (OR) 1.27; 95% confidence interval (CI) 1.14 to 1.41), in private hospitals (adjusted OR 4.34; 95% CI 3.94 to 4.79) and by surgeons whose hip arthroplasty practice has a relatively higher proportion of elective patients (adjusted OR 1.65; 95% CI 1.49 to 1.83). Conclusion Practice variation exists in the proportion of FNF patients treated with THA due to variables other than patient factors. This may reflect variation in resources available and surgeon preference, and uncertainty regarding the relative indication.

The Results of Total Hip Arthroplasty for Fractured Neck of Femur in Octogenarians

2014 ◽  
Vol 29 (3) ◽  
pp. 601-604 ◽  
Author(s):  
Will K.M. Kieffer ◽  
Edward J.C. Dawe ◽  
Edward A.O. Lindisfarne ◽  
Benedict A. Rogers ◽  
Stephen Nicol ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip

scholarly journals The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

2019 ◽  
Vol 101 (5) ◽  
pp. 342-345
Author(s):  
J Craik ◽  
R Geleit ◽  
J Hiddema ◽  
E Bray ◽  
R Hampton ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Best Practice ◽  
Complication Rates ◽  
Delayed Presentation ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip

Introduction Total hip arthroplasty is recommended for elderly patients with fractured neck of femur who are independently mobile, have few co-morbidities and are not cognitively impaired. Providing a daily total hip arthroplasty service is challenging for some units in the UK and considering that these patients may be physiologically distinct from the average hip fracture patient, loss of the best practice tariff as a result of surgical delay may be unjustified. The aim of this study was to determine whether time to surgical intervention for patients eligible for total hip arthroplasty had a negative impact on patient complications, length of stay and functional outcomes. Methods All patients undergoing total hip arthroplasty for fractured neck of femur at our institution over a ten-year period were identified. Complications and functional outcomes were compared between patients receiving total hip arthroplasty before and after 36 hours. Results Of 112 consecutive patients undergoing total hip arthroplasty, 70 responded to a questionnaire or telephone consultation. Four patients were excluded owing to delayed presentation, the presence of advanced rheumatoid arthritis or a pathological fracture. Two-thirds (64%) of the remaining 66 patients underwent surgery within 36 hours of presentation. There were no significant differences between the groups of patients receiving surgery before or after 36 hours with regard to postoperative length of stay, complications, Oxford hip scores or visual analogue scale scores for state of health. Conclusions Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff.

scholarly journals A Modified Direct Lateral Approach in Total Hip Arthroplasty

2002 ◽  
Vol 10 (1) ◽  
pp. 35-39 ◽  
Author(s):  
V.S. Pai
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip ◽  
Direct Lateral Approach

A modified lateral approach of Hardinge allows adequate access for orientation of the implant was described. Although this approach is more difficult than the posterior approach, there is a learning curve, when mastered, it'll definitely reduce the incidence of dislocation. In the Author's opinion, this approach should be used routinely for total hip arthroplasty for fractured neck of femur where the incidence of dislocation is unacceptably high using the posterior approach.

Müller straight stem total hip arthroplasty for fractured neck of femur

Injury ◽  
2006 ◽  
Vol 37 (8) ◽  
pp. 727-733 ◽  
Author(s):  
Kalpit K. Patel ◽  
Robert U. Ashford ◽  
Antonio Frasquet-Garcia ◽  
Catherine Booth ◽  
Stephen R. Joseph ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip ◽  
Straight Stem

Clinical Outcomes of Total Hip Arthroplasty for Fractured Neck of Femur in Patients Over 75 Years

2015 ◽  
Vol 30 (2) ◽  
pp. 230-234 ◽  
Author(s):  
Elizabeth C. Travis ◽  
Ruth S. Tan ◽  
Penisimani Funaki ◽  
Steve J. McChesney ◽  
Sandeep C. Patel ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip

scholarly journals Hemiarthroplasty compared with total hip arthroplasty in fractured neck of femur: a shift in national practice?

2019 ◽  
Vol 101 (2) ◽  
pp. 86-92
Author(s):  
AM Khan ◽  
M Rafferty ◽  
JS Daurka
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Rate Of Change ◽  
Digital Data ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip ◽  
Joint Registry ◽  
Hip Arthroplasties ◽  
National Practice

Introduction The aim of this study was to determine the trends in national practice regarding total hip arthroplasty compared with hemiarthroplasty in fractured neck of femur between 2010 and 2016. Materials and methods A retrospective review was conducted of NHS Digital data (England) between 2010 and 2016. ‘Emergency’ neck of femur fracture admissions, hemiarthroplasties and total hip arthroplasties were included. Elective total hip arthroplasties, revisions and prostheses relocations were excluded. Annual percentages for each operation were calculated. Trends were tabulated and displayed graphically for analysis. Results The total number of emergency neck of femur diagnoses was 257,789. Total hip arthroplasty was performed in 2217, 2737, 3305, 3686, 3670 and 3825 patients and hemiarthroplasty was performed in 21,335, 21,744, 21,115, 21,798, 21,804 and 22,163 patients for each year between 2011 and 2016, respectively. The rate of change for total hip arthroplasty slowed from 24.54% increase/year (2011–2013) to 5.24% increase/year (2013–2016). Uncemented arthroplasties decreased over the same time period. Discussion Increasing numbers of total hip arthroplasties are conducted for hip fractures; however, this trend has slowed since 2013. Possible explanations include all eligible fractures being treated with total hip arthroplasty, trauma surgeon preference for hemiarthroplasty due to lower surgical specialism or publication of individual surgeon data (National Joint Registry) which may lead to surgeons favouring hemiarthroplasties which have a lower complication rate compared to elective total hip arthroplasties.

scholarly journals Analysis of total hip arthroplasty for displaced intracapsular neck of femur fractures in a tertiary referral trauma centre

Injury Extra ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 105
Author(s):  
Z. Gamie ◽  
J. Neale ◽  
D. Shields ◽  
J. Claydon ◽  
S. Hazarika ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Trauma Centre ◽  
Tertiary Referral ◽  
Neck Of Femur ◽  
Total Hip ◽  
Femur Fractures

scholarly journals Is large femoral head a better option than a conventional femoral head primary total hip arthroplasty in Indian population

2021 ◽  
Vol 7 (2) ◽  
pp. 295
Author(s):  
Hiranya Kumar Seenappa ◽  
Karthik Mittemari Naraynamurthy ◽  
Rasiq Rashid ◽  
Shivraj Nadagouda ◽  
Vamshhikrishna Chand
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Age Group ◽  
Neck Of Femur ◽  
Large Femoral Head ◽  
Total Hip ◽  
Modified Harris Hip Score ◽  
Primary Total Hip Arthroplasty

<p class="abstract"><strong>Background: </strong>Study aimed to assess and compare the functional outcome in patients underwent the large femoral head THA and conventional femoral head THA.</p><p class="abstract"><strong>Methods:</strong> It is a comparative prospective cross sectional study conducted among the patients undergoing primary total hip arthroplasty through postero-lateral approach at department of orthopaedics Vydehi institute of medical sciences, Bengaluru during the period of July 2017 to July 2019. Patients aged between 18-80years of both genders undergoing Primary THA for Osteoarthritis (OA), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Post traumatic arthritis, Avascular necrosis (AVN), Acute fracture neck of femur, Non-union fracture neck of femur (NOF). Patients undergoing primary total hip arthroplasty in Intertrochanteric fracture, Acetabular fracture and patients undergoing Revision Hip Arthroplasty were excluded from study. Patients were grouped as the ones treated with large femoral head THA and conventional femoral head THA.</p><p class="abstract"><strong>Results: </strong>This series consisted of 36 patients with 44 diseased hips treated with primary total hip arthroplasty (THA). Out of 36 patients, 9 patients (25%) belonged to an age group of below 30 years of age, 10 patients (27.8%) belonged to the age group between 31-40 years of age, 8 patients (22.2%) belonged to the age group 41-51 years of age and 9 patients (25%) belonged to age group of 51-60 years of age. The mean level of Modified Harris Hip score and improvement of movements in all planes was found to be statistically significantly in the patients treated with large femoral head primary THA compared to those treated with conventional method. (p&lt;0.001)</p><p class="abstract"><strong>Conclusions: </strong>Study has shown improved functional outcome (Modified harris hip score) and range of movement in the patients treated with the large femoral head primary THA as compared to those treated with a conventional femoral head.</p>

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