Total hip arthroplasty for the management of hip fracture: A review of the literature

Stirton, Jacob; Maier, Jacob; Nandi, Sumon

doi:10.1016/j.jor.2019.02.012

Cited by 10 publications

(7 citation statements)

References 46 publications

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“…[3][4][5] However, the optimal surgical treatment of the elderly patient with a displaced FNF remains controversial. 6 Most geriatric patients with FNF are treated with hemiarthroplasty (HA) because this procedure is associated with shorter surgical duration, lower blood loss as well as lower dislocation rates 7 compared to THA, and therefore provides a satisfying solution particularly in very low demand individuals. However, recent reports show lower reoperation and mortality rates in patients around the 80th life year when treated with THA compared to HA, 8 as well as a significantly lower pain scores.…”

Section: Introductionmentioning

confidence: 99%

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

Flury

Finsterwald

Dimitriou

et al. 2020

Journal of Orthopaedics

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Introduction: Due to demographic changes, the annual incidence of femoral neck fractures (FNF) in patients reaching the 9th and 10th decade of life is increasing. Although active and cognitively intact elderly patients could benefit from total hip arthroplasty (THA) in case of a FNF, there is no clear consensus on whether THA should be performed in this particular subgroup of patients with very advanced age. The purpose of this study was to report the complication rate, mortality, clinical outcomes and quality-adjusted life year (QALY) gained in patients treated with total THA for FNF, while having exceeded the mean life expectancy at the time of surgery, compared to a younger control group. Materials and Methods: Patients treated with THA through a direct anterior approach (DAA) for FNF and exceeding the average life expectancy in Switzerland (age ≥ 83 y, n = 45) were matched for gender, body mass index (BMI) and ASA score with patients under the age of 83 (age = 65-83, n = 45). Perioperative complications, clinical and radiologic outcomes, as well as mortality were compared between groups. Results: Total complication rate did not differ significantly with 22.2% in the older group compared to 17.8% in the control group. The 30-day and 1-year mortality was slightly but not significantly higher in the older group (2.2% and 8.9% vs. 2.2% and 2.2%). The average QALY gained was 3.4 years and 4.1 years for the older group and their younger counterparts, respectively. Conclusion: THA through the DAA for FNF in cognitively intact and active patients might be a credible and safe option even after reaching mean life expectancy with excellent functional outcomes and similar surgery-related complications compared to patients younger than 83 years. Our results imply that an advanced age should not be considered a contraindication for THA in case of a FNF.

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Section: Introductionmentioning

confidence: 99%

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

Flury

Finsterwald

Dimitriou

et al. 2020

Journal of Orthopaedics

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“…These numbers were significantly lower compared to the literature regarding THA surgery for MFNF [ 6 ], which reports an incidence of up to 16% of patients [ 23 ]. No dislocations were observed in our cohort, one of the most feared complications in post-traumatic THA [ 23 – 26 ] with rates up to 10% of patients [ 27 ]. No patients in our cohort had the implant of a dual mobility cup to reduce the risk of dislocation [ 25 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients

Di Martino,

Pederiva,

Brunello

et al. 2023

BMC Musculoskelet Disord

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Background With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery. Methods A total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77). Results Group A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041). Conclusion The use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.

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“…Operative modalities considered for comparison of 30-day and one-year survival rates included hemiarthroplasty, intramedullary nail (IMN) and dynamic hip screw (DHS) whereas patients managed with cannulated hip screws (CHS), total hip replacement (THR) and non-operative management were excluded from this analysis. This is because patients managed with CHS and THR are usually younger and highly independent whereas the majority of patients managed with non-operative management are extremely frail and moribund [ 9 - 11 ]. In addition, for analysing one-year survival outcomes, patients were allocated to high and low NHFS groups (high NHFS=5 or above, low NHFS=4 or below).…”

Section: Methodsmentioning

confidence: 99%

Mortality in Hip Fracture Patients During the COVID-19 Pandemic: A Retrospective Analysis in a District General Hospital in the United Kingdom

Yawar¹,

Auld²,

Salmon³

et al. 2022

Cureus

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Introduction Hip fracture is commonly seen in elderly patients because of low-energy trauma. It carries significant morbidity and mortality. Scoring systems such as the Nottingham hip fracture score (NHFS) have shown a good correlation with increased mortality as the value of these scores increases. In our study, we aim to ascertain the hip fracture mortality in our population, compare the mortality in hip fractures compared to previously reported figures in literature and nationally reported figures during the first year of the COVID-19 pandemic, and also ascertain the usefulness of NHFS in predicting mortality in hip fractures. Methods We gathered mortality data on hip fracture patients admitted to our unit from January 1, 2020 to December 31, 2020. NHFS was calculated for all patients and the 30-day mortality rate was compared to previously reported hip fracture mortality rates using the standard mortality ratio (SMR). One-year mortality was stratified by placing patients in high and low NHFS groups. The log-rank test was used to compare hip fracture survival at one month and at one year in the high NHFS (NHFS >4) group and low NHFS group (NHFS value 4 or below). Additionally, a log-rank test was used to compare one-month and one-year survival in hip fractures managed with hemiarthroplasty, dynamic hip screw and intramedullary nail. Results In 2020, 388 patients were admitted with hip fractures to our unit. The crude mortality rate was 3.9% at 30 days and 20.88% at one year. Compared to the National Hip Fracture Database report for 2020, the incidence risk ratio for mortality was 0.46 (p-value<0.05). The SMR at 30 days was 0.34 (CI=0.17-0.51) and the SMR at one year was 0.63 (CI=0.49-0.77). The survival rate was higher at 30 days and one year in the low NHFS group compared to the high NHFS group (p-value<0.01). The survival rate at one month and one year were similar in groups managed with hemiarthroplasty, dynamic hip screws, and intramedullary nails (p-value>0.05). Conclusions Hip fracture mortality has been decreasing steadily and we noted a lower rate of hip fracture mortality compared to figures reported previously as per NHFS studies even though the study was conducted during the COVID-19 pandemic period. We also noted lower 30-day mortality in our hospital as compared to the national 30-day mortality rate for hip fracture patients in 2020.

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Total hip arthroplasty for the management of hip fracture: A review of the literature

Cited by 10 publications

References 46 publications

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

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

Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients

Mortality in Hip Fracture Patients During the COVID-19 Pandemic: A Retrospective Analysis in a District General Hospital in the United Kingdom

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