Should advanced age be a contraindication to total hip arthroplasty in femoral neck fracture patients? A matched-control, retrospective study

Flury, Andreas; Finsterwald, Michael; Dimitriou, Dimitris; Helmy, Naeder; Hasler, Julian; Antoniadis, Alexander

doi:10.1016/j.jor.2019.08.007

Cited by 5 publications

(15 citation statements)

References 32 publications

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“…c The difference in fracture rate was statistically significant among different diseases (P < 0.05). d With increasing height, the fracture rate gradually decreased, and the difference was statistically significant (P < 0.05) fracture incidence may be osteoporosis, not age or BMI [23]. Of course, it is well documented that in DAA, osteoporosis causes an increase in the fracture incidence [7], which was also confirmed by this study.…”

Section: Discussionsupporting

confidence: 79%

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Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

Sun

Yin

et al. 2021

J Orthop Surg Res

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Objective To provide guidelines for surgery and reduce the incidence of fracture, this study analyzed the relationship between femoral fracture and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in the lateral decubitus position. Method A retrospective series of 273 consecutive patients who underwent THA with the DAA in the lateral decubitus position was analyzed. Each surgery was performed by the same surgeon with a conventional operation bed and femoral stem. The correlations between the incidence of fracture and sex, age, body mass index (BMI), height, osteoporosis, the anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip joint disease were analyzed by univariate analysis and logistic regression analysis. Results Among all hip arthroplasty procedures, 35 hips had femoral fractures, including 30 greater trochanter fractures, 4 proximal femoral splits, and 1 femoral perforation. The incidence of fracture was 12.82%. Univariate analysis showed no significant difference in the incidence of fracture by sex, BMI, or age. However, osteoporosis caused an increase in the incidence of fracture, while the incidence of fracture decreased as height and the ASIS-GTD increased. The incidence of femoral neck fracture was lower in cases of osteonecrosis of the femoral head than in cases of other diseases. Logistic regression showed a significant correlation between osteoporosis, the ASIS-GTD, and fractures. Patients with osteoporosis had a high possibility of fracture (OR = 2.414); the possibility of fracture decreased with increasing ASIS-GTD (OR = 0.938). Conclusion Lateral decubitus DAA THA can be successfully performed using a conventional operation bed and stem, effectively saving medical resources. Osteoporosis and a shorter ASIS-GTD were independent risk factors for femoral fracture.

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Section: Discussionsupporting

confidence: 79%

“…However, the rate of osteoporosis increased with age [ 22 ]. Therefore, the real cause of the increase in the fracture incidence may be osteoporosis, not age or BMI [ 23 ]. Of course, it is well documented that in DAA, osteoporosis causes an increase in the fracture incidence [ 7 ], which was also confirmed by this study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

Sun

Yin

et al. 2021

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…The older you are, the higher the rate of osteoporosis [22]. So, the real cause of the increment of fracture incidence may be osteoporosis, not age and BMIs [23]. Of course, it was well documented that in DAA, osteoporosis causes the rise of fracture incidence [7], which was con rmed by this study also.…”

Section: Discussionsupporting

confidence: 78%

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

Sun

Yin

et al. 2020

Preprint

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Objective: In order to provide guideline to operation and reduce the incidence of fractures, this study analyze the relationship between femoral fractures and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in lateral decubitus position. Method: A consecutive retrospective series of 273 THA by DAA in lateral decubitus position were analyzed. The surgery were performed by the same surgeon with conventional operation bed and femoral stem. The correlations between incidence of fractures with gender, age, body mass index (BMI), height, osteoporosis, anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip-joint diseases were analyzed by univariate analysis and logistic regression analysis. Results: Among all hip arthroplasty, 34 cases had femoral fractures, including 29 greater trochanter fractures, 4 proximal femoral splits and 1 femoral perforation. The incidence of fractures was 13.03%. Univariate analysis: the discrepancies in incidence of fractures among genders, BMIs and age were not significant different; osteoporosis caused an increase of fractures; the incidence of fractures declined as height, ASIS-GTD increased; The incidence of femoral neck fracture and osteonecrosis of femoral head was lower than others. Logistic regression results: there was a significant correlation between osteoporosis, ASIS-GTD and fractures. Patients with osteoporosis had a high possibility of fractures (OR=2.353); the possibility of fractures decreased with an upward ASIS-GTD(OR=0.939). Conclusion: The lateral decubitus DAA THA can be successfully performed using conventional operation bed and stem, which saved medical resources effectively. Osteoporosis and ASIS-GTD were independent risk factors for femoral fractures; Short stature, inflammatory arthroses were relatively risk factors.

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“…This represents a selection bias where healthier nonagenarians are chosen for emergency THR, as per NICE guidance. The results of our study can be used to verify the safety profile of THR in selected nonagenarians, as many previous studies have done in the past [ 10 , 11 , 37 ].…”

Section: Discussionmentioning

confidence: 79%

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Al-Essah,

Curlewis,

Chan

et al. 2024

BMC Musculoskelet Disord

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Background Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians. Methods A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 – 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination. Results There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015). Conclusion There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds. Trial registration Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.

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Should advanced age be a contraindication to total hip arthroplasty in femoral neck fracture patients? A matched-control, retrospective study

Cited by 5 publications

References 32 publications

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

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