Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients

Abstract

BackgroundHemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden.Material and methodsA common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals > 60 years of age treated with modular hemiarthroplasties were reported for the period 2005–2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume).Results1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7 (SD 1.7) years. In patients over 85 years, an increased risk of reoperation was found for uncemented stems (HR = 2.2, 95% CI: 1.7–2.8), bipolar heads (HR = 1.4, CI: 1.2–1.8), posterior approach (HR = 1.4, CI: 1.2–1.8) and male sex (HR = 1.3, CI: 1.0–1.6). For patients aged 75–85 years, uncemented stems (HR = 1.6, 95% CI: 1.2–2.0) and men (HR = 1.3, CI: 1.1–1.6) carried an increased risk. Increased risk of reoperation due to infection was found for patients aged < 75 years (HR = 1.5, CI: 1.1–2.0) and for uncemented stems. For open surgery due to dislocation, the strongest risk factor was a posterior approach (HR = 2.2, CI: 1.8–2.6). Uncemented stems in particular (HR = 3.6, CI: 2.4–5.3) and male sex increased the risk of periprosthetic fracture surgery.InterpretationCemented stems and a direct lateral transgluteal approach reduced the risk of reoperation after hip fractures treated with hemiarthroplasty in patients over 75 years. Men and younger patients had a higher risk of reoperation. For the age group 60–74 years, there were no such differences in risk in this material.

What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study

“…A large registry study with unadjusted covariates found a high prevalence of preoperative neurologic conditions in patients who experienced dislocation after bipolar arthroplasty [22]. Another large registry study reported that using the posterior surgical approach increased the risk of reoperation as a result of dislocation in elderly patients with hip fracture [20], however, this study did not distinguish between unipolar and bipolar hemiarthroplasties. Another study showed that postoperative global femoral offset and limb length discrepancy were risk factors for prosthetic dislocation after hemiarthroplasty through the posterolateral approach for femoral neck fracture [17].…”

“…These are major complications of hip arthroplasty performed on patients with displaced femoral neck fractures [1,22]. The posterior surgical approach clearly increases the risk of dislocation, as supported by several clinical studies on patients with hip fracture [6,19,20]. Enocson et al [6] reported a higher dislocation proportion of 13% using the posterolateral approach than the 3% with the anterolateral approach in 720 patients with femoral neck fractures, and Pajarinen et al [19] reported a 16% dislocation rate after surgery through the posterior approach compared with 7% after the anterior approach in 338 hip fracture surgeries.…”

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…27 Posterior approaches have a higher dislocation risk of hemiarthroplasty when compared to anterolateral approaches. 95 In total hip arthroplasty, increasing the head size decreases dislocation risk. Risk of dislocation after total hip arthroplasty for hip fracture is thought to be higher than after total hip arthroplasty for osteoarthritis.…”

“…Rates of infection after hemiarthroplasty for hip fracture have been reported at 1.3% in the Scandinavian database. 95 Infections can occur immediately after the procedure or later. The patient with a wound that does not heal or continues to drain after hip replacement is likely to have infectious process.…”

Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture

“…A review of over 33 000 hemiarthroplasties of Swedish and Norwegian hip registries showed that posterior approach and use of uncemented stems was associated with increased reoperation rates. 19 Further, it has been suggested that bipolar prosthesis is more stable due to its self-aligning acetabular component. 20 The associated modularity also allows the surgeon to balance the soft tissues around the hip and potentially reduces the chances of hip dislocation.…”