Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment

Background: Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007–2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient’s diseases and procedures performed during the episode were evaluated. Results: A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). Conclusions: Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged.

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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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Profile of hip arthroplasty patients in a teaching hospital

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002007 ◽

2015 ◽

Vol 42 (2) ◽

pp. 106-110

Author(s):

Vania Regina Goveia ◽

Isabel Yovana Quispe Mendoza ◽

Bráulio Roberto Gonçalves Marinho Couto ◽

Jose Antonio Guimarães Ferreira ◽

Edson Barreto Paiva ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Teaching Hospital ◽

Hip Arthroplasty ◽

Hip Prosthesis ◽

Average Length ◽

Standing Position ◽

Orthopedic Procedures ◽

Neck Fracture ◽

Hip Arthroplasties

OBJECTIVE: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

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Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly

Chinese Medical Journal ◽

10.4103/0366-6999.192788 ◽

2016 ◽

Vol 129 (21) ◽

pp. 2630-2638 ◽

Cited By ~ 13

Author(s):

Chen-Yi Ye ◽

An Liu ◽

Ming-Yuan Xu ◽

Nwofor Samuel Nonso ◽

Rong-Xin He

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

The Elderly ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture

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Guidance for the Treatment of Femoral Neck Fracture with Precise Minimally Invasive Internal Fixation Based on the Orthopaedic Surgery Robot Positioning System

Orthopaedic Surgery ◽

10.1111/os.12451 ◽

2019 ◽

Vol 11 (3) ◽

pp. 335-340 ◽

Cited By ~ 8

Author(s):

Xin‐bao Wu ◽

Jun‐qiang Wang ◽

Xu Sun ◽

Wei Han

Keyword(s):

Femoral Neck ◽

Minimally Invasive ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Orthopaedic Surgery ◽

Positioning System ◽

Robot Positioning ◽

Neck Fracture ◽

Minimally Invasive Internal Fixation

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Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1377-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Hsuan-Hsiao Ma ◽

Te-Feng Arthur Chou ◽

Shang-Wen Tsai ◽

Cheng-Fong Chen ◽

Po-Kuei Wu ◽

...

Keyword(s):

Mortality Rate ◽

Femoral Neck ◽

Elderly Patients ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Reoperation Rate ◽

Fixation Group ◽

Neck Fracture

Abstract Background Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures. Methods We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration. Results Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group. Conclusions Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.

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