| 1. |
- Hansson, Susanne, et al.
(författare)
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Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients.
- 2015
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Ingår i: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383. ; 46:11, s. 2206-2211
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Tidskriftsartikel (refereegranskat)abstract
- The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function.
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| 2. |
- Jobory, Ammar, et al.
(författare)
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Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register
- 2021
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:4, s. 413-418
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Reported revision rates due to dislocation after hemiarthroplasty span a wide range. Dislocations treated with closed reduction are rarely reported despite the fact that they can be expected to constitute most of the dislocations that occur. We aimed to describe the total dislocation rate on the national level, and to identify risk factors for dislocation. Patients and methods - We co-processed a national cohort of 25,678 patients in the Swedish Hip Arthroplasty Register, with the National Patient Register (NPR) and Statistics Sweden. Dislocation was defined as the occurrence of any ICD-10 or procedural code related to hip dislocation recorded in the NPR, with a minimum of 1-year-follow-up. In theory, all early dislocations should thereby be traced, including those treated with closed reduction only. Results - 366/13,769 (2.7%) patients operated on with direct lateral approach dislocated, compared with 850/11,834 (7.2%) of those with posterior approach. Posterior approach was the strongest risk factor for dislocation (OR = 2.7; 95% CI 2.3-3.1), followed by dementia (OR = 1.3; CI 1.1-1.5). The older the patients, the lower the risk of dislocation (OR = 0.98 per year of age; CI 0.98-1.0). Neither bipolar design nor cementless stems influenced the risk. Interpretation - The choice of posterior approach and dementia was associated with an increased dislocation risk. When hips treated with closed reduction were identified, the frequency of dislocation with use of direct lateral and posterior approach more than doubled and tripled, respectively, compared with when only revisions due to dislocation are measured.
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| 3. |
- Jobory, Ammar, et al.
(författare)
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Hip precautions not meaningful after hemiarthroplasty due to hip fracture. Cluster-randomized study of 394 patients operated with direct anterolateral approach.
- 2019
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Ingår i: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383. ; 50:7, s. 1318-1323
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to compare two treatment regimes, one with and one without postoperative precautions in hemiarthroplasty patients, in terms of dislocation rate and patient-reported outcome. Direct lateral approach was used.394 patients were included in a cluster-randomized study 2010-2014. Depending on which ward they were admitted to, they were allotted to free rehabilitation (non-precaution group, NPG, n=226) or our conventional regime with precautions and mandatory assistive equipment (precaution group, PG, n=168). Patients were followed during hospital stay, at 6 weeks (postal questionnaire), 3 month (visit) and 6 months (reading of medical records) by means of function tests, health-related quality of life (EQ-5D) and other patient-reported outcome measures (PROM).One patient in each group had dislocation(s). We found no statistically significant differences regarding in-hospital-mortality, severe adverse events, EQ5D index or other PROM. In the NPG, rehabilitation personnel had significantly shorter work effort during hospital stay (p<0.001). 7 in the NPG and 13 of the PG had reoperations (p=0.038), 4 and 8 had deep infections, 3 and 5 periprosthetic fractures.Rehabilitation precautions are not needed for preventing dislocation when direct lateral approach is used. Without precautions, rehabilitation personnel implement significantly shorter work effort during hospital. We found no statistically significant differences regarding PROM and complications except for somewhat more reoperations in total in the precaution group.
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| 4. |
- Leonardsson, Olof, et al.
(författare)
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Changes in implant choice and surgical technique for hemiarthroplasty: 21,346 procedures from the Swedish Hip Arthroplasty Register 2005-2009
- 2012
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 83:1, s. 7-13
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Treatment of displaced femoral neck fractures in Sweden has shifted towards more arthroplasties, especially hemiarthroplasties. We describe the hemiarthroplasty population in Sweden 2005 through 2009. Methods Since 2005, the Swedish Hip Arthroplasty Register has registered hemiarthroplasties on a national basis. We assessed hemiarthroplasty procedures in the Register 2005-2009 regarding patient details, implants, and surgical techniques. Completeness of recordings was calculated compared to the Swedish National Patient Register. Results Completeness increased from 89% to 96% during the study period. 21,346 hemiarthroplasty procedures were assessed. The relative number of patients with femoral neck fracture as diagnosis increased from 91% to 94%; the proportion of men increased from 27% to 30%. The median age increased from 83 to 84 years in men and from 84 to 85 years in women. Patients classified as having evident cognitive impairment increased from 19% to 22%. More men than women were ASA 4. The proportion of monoblock-type implants (Austin-Moore and Thompson) decreased from 18% to 0.9%. Modular implants increased generally, but in 2009 bipolar implants decreased in favor of unipolar implants. Lubinus and Exeter stems, and Mega Caput and Vario Cup implant heads were most common. The use of uncemented implants decreased from 10% to 3%. Use of the anterolateral approach increased from 47% to 56%. Interpretation Important changes in surgical technique and implant choice occurred during the observation period. We interpret these changes as being reflections of the continuing effort by Swedish orthopedic surgeons to improve the quality of treatment, because the changes are consistent with recent findings in the Swedish Hip Arthroplasty Register and in other scientific studies.
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| 5. |
- Leonardsson, Olof, et al.
(författare)
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Higher risk of reoperation for bipolar and uncemented hemiarthroplasty : 23,509 procedures after femoral neck fractures from the Swedish Hip Arthroplasty Register, 2005-2010
- 2012
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 83:5, s. 459-466
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Hemiarthroplasty as treatment for femoral neck fractures has increased markedly in Sweden during the last decade. In this prospective observational study, we wanted to identify risk factors for reoperation in modular hemiarthroplasties and to evaluate mortality in this patient group. Patients and methods We assessed 23,509 procedures from the Swedish Hip Arthroplasty Register using the most common surgical approaches with modular uni- or bipolar hemiarthroplasties related to fractures in the period 2005-2010. Completeness of registration (individual procedures) was 89-96%. The median age was 85 years and the median follow-up time was 18 months. Results 3.8% underwent reoperation (any further hip surgery), most often because of implant dislocation or infection. The risk of reoperation (Cox regression) was higher for uncemented stems (hazard ratio (HR) = 1.5), mainly because of periprosthetic femoral fractures. Bipolar implants had a higher risk of reoperation irrespective of cause (HR = 1.3), because of dislocation (1.4), because of infection (1.3), and because of periprosthetic fracture (1.7). The risk of reoperation due to acetabular erosion was lower (0.30) than for unipolar implants, but reoperation for this complication was rare (1.7 per thousand). Procedures resulting from failed internal fixation had a more than doubled risk; the risk was also higher for males and for younger patients. The surgical approach had no influence on the risk of reoperation generally, but the anterolateral transgluteal approach was associated with a lower risk of reoperation due to dislocation (HR = 0.7). At 1 year, the mortality was 24%. Men had a higher risk of death than women (1.8). Interpretation We recommend cemented hemiarthroplasties and the anterolateral transgluteal approach. We also suggest that unipolar implants should be used, at least for the oldest and frailest patients.
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| 6. |
- Leonardsson, Olof, et al.
(författare)
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Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients.
- 2010
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Ingår i: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 92:3, s. 406-412
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Tidskriftsartikel (refereegranskat)abstract
- In a series of 450 patients over 70 years of age with displaced fractures of the femoral neck sustained between 1995 and 1997 treatment was randomised either to internal fixation or replacement. Depending on age and level of activity the latter was either a total hip replacement or a hemiarthroplasty. Patients who were confused or bed-ridden were excluded, as were those with rheumatoid arthritis. At ten years there were 99 failures (45.6%) after internal fixation compared with 17 (8.8%) after replacement. The rate of mortality was high at 75% at ten years, and was the same in both groups at all times. Patient-reported pain and function were similar in both groups at five and ten years. Those with successfully healed fractures had more hip pain and reduction of mobility at four months compared with patients with an uncomplicated replacement, and they never attained a better outcome than the latter patients regarding pain or function. Primary replacement gave reliable long-term results in patients with a displaced fracture of the femoral neck.
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| 7. |
- Leonardsson, Olof, et al.
(författare)
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Outcome after primary and secondary replacement for subcapital fracture of the hip in 10 264 patients.
- 2009
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Ingår i: The Journal of bone and joint surgery. British volume. - 0301-620X .- 2044-5377. ; 91:5, s. 595-600
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Tidskriftsartikel (refereegranskat)abstract
- Between 1999 and 2005, 10 264 patients who had undergone total hip replacement (THR) for subcapital fracture of the hip were compared with 76 520 in whom THR had been performed for other reasons. All the cases were identified through the Swedish Hip Arthroplasty Register. The THRs performed as primary treatment for fracture were also compared with those done after failure of internal fixation. After seven years the rate of revision was higher in THR after fracture (4.4% vs 2.9%). Dislocation and periprosthetic fracture were the most common causes of revision. The risk was higher in men than in women. The type of femoral component and the surgical approach influenced the risk. After correction for gender, type of component and the surgical approach the revision rates were similar in the primary and secondary fracture THR groups. Total hip replacement is therefore a safe method for both the primary and secondary management of fracture of the hip.
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| 8. |
- Leonardsson, Olof, et al.
(författare)
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Patient-Reported Outcome After Displaced Femoral Neck Fracture : A National Survey of 4467 Patients
- 2013
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : American Orthopaedic Association. - 0021-9355 .- 1535-1386. ; 95:18, s. 1693-1699
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Tidskriftsartikel (refereegranskat)abstract
- Background: Arthroplasty appears to be superior to internal fixation, with regard to complication rates, as a treatment for displaced femoral neck fractures. Less is known about the result as perceived by the patient. The aims of this prospective observational study were (1) to determine whether patient-reported outcomes after a displaced femoral neck fracture can be evaluated on a nationwide basis by means of a mailed survey, and (2) to evaluate differences among treatment methods with respect to patient-reported pain, health-related quality of life, and satisfaction with the surgical result.Methods: Through collaboration between the Swedish Hip Arthroplasty Register and the Swedish National Hip Fracture Register, 5902 patients (median age, eighty-four years; range, eighteen to 103 years) treated with internal fixation, total hip arthroplasty, or hemiarthroplasty for a displaced femoral neck fracture were identified. A composite questionnaire, including the EQ-5D and visual analog scales for pain and for satisfaction with the surgical result, was mailed to the 4467 patients who remained alive (median follow-up, fourteen months; range, seven to twenty-two months).Results: The total response rate was 79% (n = 3513); 72% to 75% of the patients completed each of the questionnaire sections. Both patients below and patients above seventy years of age treated with total hip arthroplasty reported less pain and were more satisfied compared with those treated with internal fixation or hemiarthroplasty (although the differences between total hip arthroplasty and hemiarthroplasty in patients below seventy years of age did not reach significance).Conclusions: A mailed patient-reported outcomes questionnaire is a feasible method for national follow-up of hip fractures, with an acceptable response rate. The study also suggests that total hip arthroplasty as a treatment for femoral neck fracture is associated with less pain and greater satisfaction at short-term follow-up compared with internal fixation and hemiarthroplasty, both in patients younger and older than seventy years.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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| 9. |
- Leonardsson, Olof, et al.
(författare)
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Patient-reported outcome after displaced femoral neck fracture: a national survey of 4467 patients.
- 2013
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Ingår i: The Journal of bone and joint surgery. American volume. - 1535-1386. ; 95:18, s. 1693-9
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Tidskriftsartikel (refereegranskat)abstract
- Arthroplasty appears to be superior to internal fixation, with regard to complication rates, as a treatment for displaced femoral neck fractures. Less is known about the result as perceived by the patient. The aims of this prospective observational study were (1) to determine whether patient-reported outcomes after a displaced femoral neck fracture can be evaluated on a nationwide basis by means of a mailed survey, and (2) to evaluate differences among treatment methods with respect to patient-reported pain, health-related quality of life, and satisfaction with the surgical result.
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| 10. |
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