31.
Reduced reoperation rate of cemented hemiarthroplasty (HA)
compared with cementless HA and internal fixation of displaced femoral
neck fracture up to 19 years after initial surgery in 75+ year old patients
Bjarke Viberg, Søren Overgaard, Jens Lauritsen, Ole Ovesen
Orthopaedic Surgery and Traumatology Institute of Clinical Research / Odense
University Hospital; Orthopaedic Surgery and Traumatology, Institute of
Clinical Research / Odense University Hospital; Orthopaedic Surgery and
Traumatology, Institute of Public Health / Odense University Hospital;
Orthopaedic Surgery and Traumatology, Institute of Clinical Research /
Odense University Hospital
Background:
Elderly patients with displaced femoral neck fractures are
commonly treated with a hemiarthroplasty (HA) but little is known about long-
term failure.
Purpose / Aim of Study:
Compare reoperation rates for 75+ year old patients
with displaced femoral neck fractures for three different HA’s and internal
fixation (IF) after 19 years.
Materials and Methods:
Four different hospitals with clearly defined
guidelines for treatment of 75+ year old patients with a displaced femoral neck
fracture were consecutively included. Odense University Hospital (1991-
1993):
n=180, IF; Svendborg Sygehus (1991-1995): n=203, uncemented
bipolar Ultima HA; Århus Kommune Hospital (1991-1995): n=209, cemented
unipolar Hastings HA; Hillerød Hospital (1991-1998): n=158, uncemented
hydroxyapatite-coated bipolar Furlong HA. Failure was defined as any
procedure that led to reoperation with loss/change of hip implant (simple screw
removal excluded) or periprosthetic fracture. Data was retrieved from patient
files, region based Patient Administrative System, and The National Registry
of Patients at the end of 2010. Survival analysis was applied with adjustment
for co-morbidity (Charlson index), sex and age. Patients at risk at entry were
750,
at 5 years 200, at 10 years 57, and at 15 years 11; attrition mostly due to
high mortality.
Findings / Results:
There was a significant reduced hazard ratio (HR) for the
Hasting HA (HR=0.27 (0.13;0.53), p<0.000, absolute failure rate (AFR) 5.6
%)
but not for the Ultima HA (HR=0.58 (0.34;1.00), p=0.051, AFR 10.8 %)
and the Furlong HA (HR=0.98 (0.58;1.65), p=0.788, AFR 15.8 %) compared
with IF (reference HR=1, AFR 18.3 %).
Conclusions:
Cemented HA has superior long-term hip survival rate compared
to IF and cementless HA for patients above 75 years with a displaced femoral
neck fracture.
