Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95% Confidence interval (CI), 2.21–3.27; p < 0.001; RD, 2.82; 95% CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.

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Association between Hospital Surgical Volume and Complications after Total Hip Arthroplasty in Femoral Neck Fracture: a Propensity Score-matched Cohort Study

Injury ◽

10.1016/j.injury.2021.02.092 ◽

2021 ◽

Author(s):

Takahisa Ogawa ◽

Tetsuya Jinno ◽

Mutsuko Moriwaki ◽

Toshitaka Yoshii ◽

Ara Nazarian ◽

...

Keyword(s):

Cohort Study ◽

Total Hip Arthroplasty ◽

Propensity Score ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Arthroplasty ◽

Matched Cohort ◽

Surgical Volume ◽

Total Hip ◽

Neck Fracture

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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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