Patient and implant survival following 4323 total hip replacements for acute femoral neck fracture: A retrospective cohort study using National Joint Registry data
The National Joint Registry for England and Wales, The NJR Centre, Peoplebuilding Estate, Maylands Avenue, Hemel Hempstead HP2 4NW, UK.The Bone & Joint Journal (Impact Factor: 3.31). 11/2012; 94(11):1557-66. DOI: 10.1302/0301-620X.94B11.29689
United Kingdom National Institute for Health and Clinical Excellence guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractures of the femoral neck in cognitively intact patients, who were independently mobile prior to the injury. This study aimed to analyse the risk factors associated with revision of the implant and mortality following THR, and to quantify risk. National Joint Registry data recording a THR performed for acute fracture of the femoral neck between 2003 and 2010 were analysed. Cox proportional hazards models were used to investigate the extent to which risk of revision was related to specific covariates. Multivariable logistic regression was used to analyse factors affecting peri-operative mortality (< 90 days). A total of 4323 procedures were studied. There were 80 patients who had undergone revision surgery at the time of censoring (five-year revision rate 3.25%, 95% confidence interval 2.44 to 4.07) and 137 patients (3.2%) patients died within 90 days. After adjusting for patient and surgeon characteristics, an increased risk of revision was associated with the use of cementless prostheses compared with cemented (hazard ratio (HR) 1.33, p = 0.021). Revision was independent of bearing surface and head size. The risk of mortality within 90 days was significantly increased with higher American Society of Anesthesiologists (ASA) grade (grade 3: odds ratio (OR) 4.04, p < 0.001; grade 4/5: OR 20.26, p < 0.001; both compared with grades 1/2) and older age (≥ 75 years: OR 1.65, p = 0.025), but reduced over the study period (9% relative risk reduction per year). THR is a good option in patients aged < 75 years and with ASA 1/2. Cementation of the femoral component does not adversely affect peri-operative mortality but improves survival of the implant in the mid-term when compared with cementless femoral components. There are no benefits of using head sizes > 28 mm or bearings other than metal-on-polyethylene. More research is required to determine the benefits of THR over hemiarthroplasty in older patients and those with ASA grades > 2.
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ABSTRACT: The main indications for internal fixation of intracapsular fractures are undisplaced and minimally displaced fractures and displaced intracapsular fractures in patients aged under seventy years. Closed reduction is to be preferred to open reduction. Different implants may have to be used, with current practice favouring two or three parallel cannulated cancellous screws. Attention to surgical details of fracture reduction and implant positioning will minimise the risk of complications.
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ABSTRACT: Total hip arthroplasty (THA) has been associated with excellent functional outcomes and survival rates (Cushner et al., 2010 ). Selection of acetabular shell and technique of implantation is an important factor as is the stem for a successful THA. Both cemented all-polyethylene cups and cementless sockets have benefited from improvements in surgical techniques, cup designs, and bearing surfaces. This paper is a review of the current literature that focuses on the options for the acetabular components of a modern total hip replacement, aiming to answer common questions and controversies on this topic.
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