TY - JOUR
T1 - Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data
AU - Jameson, Simon S.
AU - Lees, Deborah
AU - James, Philip
AU - Johnson, Andrew
AU - Nachtsheim, Christopher
AU - McVie, James L.
AU - Rangan, Amar
AU - Muller, Scott D.
AU - Reed, Mike R.
PY - 2013/12
Y1 - 2013/12
N2 - Background The treatment of choice for intracapsular neck of femur (NOF) fractures in younger, more active patients remains unknown. Some surgeons advocate total hip replacement (THR). Aim This study aimed to compare complications following THR and hemiarthroplasty using the Hospital Episode Statistics (HES) database in England. Method Dislocation and revision rates were extracted for all patients with NOF fracture who underwent either cemented hemiarthroplasty or cemented THR between January 2005 and December 2008. To make a 'like for like' comparison all 3866 THR patients were matched to 3866 hemiarthroplasty patients (from a total of 41,343) in terms of age, sex and Charlson score. Results and conclusion Eighteen-month dislocation was significantly higher in the THR group (2.4% vs. 0.5%, odds ratio (OR) 3.90 (2.99-5.05), p < 0.001). This difference was sustained at the 4-year stage (2.9% vs. 0.9%, OR 3.18 (1.58-6.94), p = 0.001) in a subset of patients with longer follow-up. There was no significant difference in revision rate up to 4 years (1.8% vs. 2.1%, OR 0.85 (0.46-1.55), p = 0.666). In this national analysis of matched patients short- and medium-term dislocation rates following THR were significantly higher than following cemented hemiarthroplasty, without any difference in revision rates at 4 years. The low risk of dislocation may be acceptable in order to experience the apparent functional benefits of THR.
AB - Background The treatment of choice for intracapsular neck of femur (NOF) fractures in younger, more active patients remains unknown. Some surgeons advocate total hip replacement (THR). Aim This study aimed to compare complications following THR and hemiarthroplasty using the Hospital Episode Statistics (HES) database in England. Method Dislocation and revision rates were extracted for all patients with NOF fracture who underwent either cemented hemiarthroplasty or cemented THR between January 2005 and December 2008. To make a 'like for like' comparison all 3866 THR patients were matched to 3866 hemiarthroplasty patients (from a total of 41,343) in terms of age, sex and Charlson score. Results and conclusion Eighteen-month dislocation was significantly higher in the THR group (2.4% vs. 0.5%, odds ratio (OR) 3.90 (2.99-5.05), p < 0.001). This difference was sustained at the 4-year stage (2.9% vs. 0.9%, OR 3.18 (1.58-6.94), p = 0.001) in a subset of patients with longer follow-up. There was no significant difference in revision rate up to 4 years (1.8% vs. 2.1%, OR 0.85 (0.46-1.55), p = 0.666). In this national analysis of matched patients short- and medium-term dislocation rates following THR were significantly higher than following cemented hemiarthroplasty, without any difference in revision rates at 4 years. The low risk of dislocation may be acceptable in order to experience the apparent functional benefits of THR.
KW - Hemiarthroplasty
KW - Hip surgery
KW - Hip trauma
KW - Intracapsular hip fracture
KW - Management
KW - National joint register
KW - Outcomes
KW - Proximal femoral fracture
KW - Total hip replacement
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U2 - 10.1016/j.injury.2013.03.021
DO - 10.1016/j.injury.2013.03.021
M3 - Article
C2 - 23618782
AN - SCOPUS:84887051903
SN - 0020-1383
VL - 44
SP - 1940
EP - 1944
JO - Injury
JF - Injury
IS - 12
ER -