Early Results after the Treatment with Total Hip Arthroplasty with Larger Diameter Femoral Head versus Bipolar Arthroplasty in Patients with Femoral Neck Fractures

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

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Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials

International Orthopaedics ◽

10.1007/s00264-012-1569-7 ◽

2012 ◽

Vol 36 (8) ◽

pp. 1549-1560 ◽

Cited By ~ 162

Author(s):

Paul T. P. W. Burgers ◽

Arnoud R. Van Geene ◽

Michel P. J. Van den Bekerom ◽

Esther M. M. Van Lieshout ◽

Bastiaan Blom ◽

...

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Randomized Trials ◽

Meta Analysis ◽

Femoral Neck Fractures ◽

Total Hip ◽

Healthy Elderly ◽

Displaced Femoral Neck Fractures

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Clinical Outcomes of Bipolar Hemiarthroplasty versus Total Hip Arthroplasty: Assessing the Potential Impact of Cement Use and Pre-Injury Activity Levels in Elderly Patients with Femoral Neck Fractures

Hip & Pelvis ◽

10.5371/hp.2019.31.2.63 ◽

2019 ◽

Vol 31 (2) ◽

pp. 63 ◽

Cited By ~ 1

Author(s):

Jun-Il Yoo ◽

Yong-Han Cha ◽

Jung-Taek Kim ◽

Chan-Ho Park

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Elderly Patients ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Activity Levels ◽

Total Hip ◽

Potential Impact

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Outcomes of total hip arthroplasty using dualmobility cups for femoral neck fractures: a systematic review and meta-analysis

Hip International ◽

10.1177/1120700020926652 ◽

2020 ◽

pp. 112070002092665

Author(s):

Syed H Mufarrih ◽

Nada Q Qureshi ◽

Bassam Masri ◽

Shahryar Noordin

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Mortality Rates ◽

Femoral Neck Fractures ◽

Cochrane Library ◽

Total Hip ◽

The Mean

Objectives: Femoral neck fractures (FNFs), with up to 15% mortality, are prominent orthopaedic emergencies. After treating FNFs, dislocation is another challenge increasing morbidity, mortality and treatment costs substantially. The emerging dual-mobility cup (DMC) may decrease dislocation rates following total hip arthroplasty (THA) for FNFs. We performed a systematic review of literature reporting dislocation and mortality rates with DMC-THA for the treatment of FNFs. Methods: 2 authors independently searched PubMed (MEDLINE), Google Scholar and Cochrane library for studies reporting dislocation and mortality rates for FNFs treated with DMC-THA since inception up to January 2019. Data on outcomes of interest was extracted from all studies and assessed for eligibility for a meta-analysis. Results: Out of 522 search results, 18 studies were included in the systematic review and 4 in the meta-analysis. The mean rate of dislocation following DMC-THA for FNFs was found to be 1.87% ± 2.11, with a 1-year mortality rate of 14.0% ± 10.55. Results of meta-analysis showed that dislocation and 1-year postoperative mortality rates were significantly lower for DMC-THA with a risk ratio 0.31 (95% CI, 0.16–0.59; I2 = 0%, p = 0.0003) and 0.55 (0.40, 0.77; I2 = 0%, p = 0.003) respectively when compared to biploar hemiathroplasty (BHA). Conclusions: The mean dislocation and mortality rates in DMC-THA are lower than previously reported rates for THA with single cup and comparable to unipolar and bipolar hemiarthroplasty. Further research involving randomised control trials to assess differences in outcomes, longevity and cost-effectiveness needs to be conducted to make recommendations for the use of DMC in treating FNFs.

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Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients

Hip International ◽

10.1177/1120700018816924 ◽

2018 ◽

Vol 29 (6) ◽

pp. 674-679 ◽

Cited By ~ 3

Author(s):

Scott M Eskildsen ◽

Ganesh V Kamath ◽

Daniel J Del Gaizo

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Femoral Neck Fractures ◽

National Database ◽

Medicare Patient ◽

Entire Study ◽

Total Hip ◽

Significant Difference ◽

Medicare Patients

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

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Surgical Treatment of Femoral Neck Fractures: A Brief Review

Geriatrics ◽

10.3390/geriatrics5020022 ◽

2020 ◽

Vol 5 (2) ◽

pp. 22

Author(s):

Ellen Lutnick ◽

Jeansol Kang ◽

David M. Freccero

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Traumatic Injury ◽

Femoral Neck Fractures ◽

Geriatric Population ◽

Total Hip ◽

The Difference

Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.

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