Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision

Sophie Moerman, Nina M C Mathijssen, Wim E Tuinebreijer, Anne J H Vochteloo, Rob G H H Nelissen, Sophie Moerman, Nina M C Mathijssen, Wim E Tuinebreijer, Anne J H Vochteloo, Rob G H H Nelissen

Abstract

Background and purpose - In the Netherlands about 40% of hip fractures are treated with a hemiarthroplasty (HA) or a total hip arthroplasty (THA). Although these procedures are claimed to have fewer complications than osteosynthesis (i.e., reoperation), complications still occur. Analyses of data from national registries with adequate completeness of revision surgery are important to establish guidelines to diminish the risk for revision. We identified risk factors for revision. Patients and methods - All patients older than 50 years of age with a hip fracture treated with arthroplasty by orthopedic surgeons and registered in the (national) Dutch arthroplasty register (LROI) were included in the study. In this register, patient characteristics and surgical details were prospectively collected. Revision surgery and reasons for revision were evaluated. A proportional hazard ratio model for revision was created using competing risk analysis (with death as competing risk). Results - 1-year revision rate of HA was (cumulative incidence function [CIF] 1.6% (95% CI 1.4-1.8) and THA 2.4% (CI 2.0-2.7). Dislocation was the most common reason for revision in both groups (HA 29%, THA 41%). Male sex, age under 80 years, posterolateral approach, and uncemented stem fixation were risk factors for revision in both THA and HA. THA patients with ASA classification III/IV were revised more often, whereas revision in the HA cohort was performed more often in ASA I/II patients. Interpretation - After arthroplasty of hip fractures, both a posterolateral approach and an uncemented hip stem have higher risks for revision surgery compared with an anterolateral approach and an cemented stem.

Figures

Figure 1.
Figure 1.
Cumulative incidence function (CIF) of revision estimates from competing risks data (1 – survival) for patients treated with HA and THA (n = 30,830).

References

    1. Australian Orthopaedic Association National Joint Replacement Registry Annual Report 2016. .
    1. Baker R P, Squires B, Gargan M F, Bannister G C. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck (a randomized, controlled trial). J Bone Joint Surg 2006; 88(12): 2583–9.
    1. Batailler C, Fary C, Verdier R, Aslanian T, Caton J, Lustig S. The evolution of outcomes and indications for the dual-mobility cup: a systematic review. Int Orthop 2017; 41(3): 645–59.
    1. Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist a, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 2007; 89(2): 160–5.
    1. Dale H, Skramm I, Lower H L, Eriksen H M, Espehaug B, Furnes O, Skjeldestad F E, Havelin L I, Engesaeter L B. Infection after primary hip arthroplasty. Acta Orthop 2011; 82(6): 646–54.
    1. De Martino I, D’Apolito R, Soranoglou V G, Poultsides L A, Sculco P K, Sculco T P. Dislocation following total hip arthroplasty using dual mobility acetabular components: a systematic review. Bone Joint J 2017; 99B(1): 18–24.
    1. Donaldson A J, Tomson H E, Harper N J, Kenny N W. Bone cement implantation syndrome (BCIS). Br J Anaesth 2009; 102(1): 12–22.
    1. Dutch Arthroplasty Register (LROI) , site accessed on 03-12-2017.
    1. Gao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: a meta-analysis. Clin Orthop Relat Res 2012; 470(6): 1782–91.
    1. Gillam M H, Ryan P, Graves S E, Miller L N, de Steiger R N, Salter A. Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 2010; 81(5): 548–55.
    1. Gjertsen J-E, Fenstad A M, Leonardsson O, Engesaeter L B, Kärrholm J, Furnes O, Garellick G, Rogmark C. Hemiarthroplasties after hip fractures in Norway and Sweden: a collaboration between the Norwegian and Swedish national registries. Hip Int 2014; 24(3): 223–30.
    1. Hedbeck C J, Enocson A, Lapidus G, Blomfeldt R, Tornkvist H, Ponzer S, Tidermark J. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 2011; 93(5): 445–50.
    1. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 2010; 340(7761): 1397.
    1. Johnston L E, Parker M J. Hip fractures and chronic alcohol excess: a series of 7,023 cases. Hip Int 2014; 24(6): 644–9.
    1. Keurentjes J C, Fiocco M, Schreurs B W, Pijls B G, Nouta K A, Nelissen R G H H. Revision surgery is overestimated in hip replacement. Bone Joint Res 2012; 1(10): 258–262.
    1. Kosola J, Kaipia A, Laitinen M K, Nieminen J. Complications after surgical treatment of femoral neck fractures in men with alcohol dependence syndrome: retrospective register analysis of 154 cases. Arch Orthop Trauma Surg 2017; 137(7): 967–73.
    1. Kristensen T B, Vinje T, Havelin L I, Engesaeter L B, Gjertsen J-E. Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture: 20,908 patients from the Norwegian Hip Fracture Register. Acta Orthop 2016; 87(1): 29–34.
    1. Landelijke Registratie Orthopedische Implantaten LROI-rapportage 2013; 2013.
    1. Landelijke Registratie Orthopedische Implantaten LROI-rapportage 2015; 2015.
    1. Leonardsson O, Garellick G, Kärrholm J, Akesson K, Rogmark C. Changes in implant choice and surgical technique for hemiarthroplasty: 21,346 procedures from the Swedish Hip Arthroplasty Register 2005-2009. Acta Orthop 2012a; 83(1): 7–13.
    1. Leonardsson O, Kärrholm J, Åkesson K, Garellick G, Rogmark C. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop 2012b; 83(5): 459–66.
    1. Moerman S, Mathijssen N M C, Niesten D D, Riedijk R, Rijnberg W J, Koëter S, Kremers van de Hei K, Tuinebreier W E, Molenaar T L, Nelissen R G H H, Vochteloo A J H. More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC Musculoskelet Disord 2017; 18(1): 169.
    1. NICE Hip fracture: the management of hip fracture in adults. NICE clinical guideline 124; 2011.
    1. NVT, NOV Proximale femur fracturen (richtlijn). 2016.
    1. DIS open data [Internet]. [cited 2017. Nov 23].
    1. Pepe M S, Mori M. Kaplan-Meier, marginal or conditional probability curves in summarizing competing risks failure time data? Stat Med 1993;12(8):737–51.
    1. Ranstam J, Robertsson O. The Cox model is better than the Fine and Gray model when estimating relative revision risks from arthroplasty register data. Acta Orthop 2017; 88(6): 578–80.
    1. Rogmark C, Fenstad A M, Leonardsson O, Engesaeter L B, Kärrholm J, Furnes O, Garellick G, Gjertsen J-E. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop 2014; 85(1): 18–25.
    1. Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 2016; 98-B(3): 291–7.
    1. Stafford G H, Charman S C, Borroff M J, Newell C, Tucker J K. Total hip replacement for the treatment of acute femoral neck fractures: results from the National Joint Registry of England and Wales at 3-5 years after surgery. Ann R Coll Surg Engl 2012; 94(3): 193–8.
    1. Tabori-Jensen S, Hansen T B, Bøvling S, Aalund P, Homilius M, Stilling M. Good function and high patient satisfaction at mean 2.8 years after dual mobility THA following femoral neck fracture: a cross-sectional study of 124 patients. Clin Interv Aging 2018; 13: 615–21.
    1. van den Bekerom M P J, Hilverdink E F, Sierevelt I N, Reuling E M B P, Schnater J M, Bonke H, Goslings J C, van Dijk C N, Raaymakers E L F B. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br 2010; 92(10): 1422–8.
    1. van der Pas S L, Nelissen R G H H, Fiocco M. Patients with staged bilateral total joint arthroplasty in registries. J Bone Joint Surg 2017; 82: 1–8.
    1. van Steenbergen L N, Denissen G A W, Spooren A, van Rooden S M, van Oosterhout F J, Morrenhof J W, Nelissen R G H H. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86(4): 498–505
    1. Wang F, Zhang H, Zhang Z, Ma C, Feng X. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 2015; 16: 229.

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