| 1. |
- Gjertsen, Jan-Erik, et al.
(författare)
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Hemiarthroplasties after hip fractures in Norway and Sweden: a collaboration between the Norwegian and Swedish national registries
- 2014
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Ingår i: HIP International. - : SAGE Publications. - 1724-6067 .- 1120-7000. ; 24:3, s. 223-230
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Tidskriftsartikel (refereegranskat)abstract
- National registration of hemiarthroplasties after hip fractures has been established in both Norway and Sweden. We aimed to investigate differences in demographics, choice of implant selection, surgical approaches, and reoperations between the Norwegian Hip Fracture Register (NHFR) and the Swedish Hip Arthroplasty Register (SHAR). As part of the Nordic Arthroplasty Register Association (NARA) project a common hemiarthroplasty dataset has been established. 36,989 primary hemiarthroplasties (HAs) for acute hip fractures reported to NHFR (n = 12,761) and SHAR (n = 24,228) for the period 2005-2010 were included. Cemented prostheses were used in 78% of the operations in Norway and in 95% of the patients in Sweden. In Norway HAs almost exclusively had bipolar design (98%), whereas in Sweden HAs with unipolar design were used in 42% of the cases. Monoblock (non-modular) prostheses were uncommon, but still more frequently used in Sweden than in Norway (6.9% and 2.1% respectively). The lateral approach was more common in Norway (83%) than in Sweden (52%), where the posterior approach was used in 42% of the cases. The five-year survival of all HAs was 95.5% (95% CI: 94.8-96.2) in Norway and 94.8% (95% CI: 94.4-95.3) in Sweden. We concluded that surprisingly large differences between the two countries in demographics, implant design, and surgical technique had been revealed. This common dataset enables further investigations of the impact of these differences on revision rates and mortality.
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| 2. |
- 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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| 3. |
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| 4. |
- Leonardsson, Olof
(författare)
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Arthroplasty for Femoral Neck Fracture. Results of a nationwide implementation.
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hip fractures are devastating for the individual and a substantial economic burden for society. The treatment for displaced femoral neck fracture is a choice between internal fixation, total hip arthroplasty and hemiarthroplasty. As a result of several randomized trials, the treatment has shifted in Sweden from mostly internal fixation towards arthroplasties. There have been concerns about long-term arthroplasty complications such as aseptic loosening and periprosthetic fracture. In addition to investigating this issue, the focus of this thesis was on identifying the optimal treatment methods for patients with this displaced femoral neck fractures, regarding choice of implant and surgical technique. In a 10-year follow-up of a randomized multicenter trial on 450 mentally lucid and relatively healthy patients above 70 years with displaced femoral neck fractures, patients treated with internal fixation had continuously higher rates of major complications compared to those treated with arthroplasty (46 % compared to 9 % at 10 years). Patients with successful healed fractures reported more pain and reduction of mobility at four months than those successfully treated with arthroplasty, and they never attained a better result than the latter. Those results indicate that there are no excess long-term complications after arthroplasty and refute the assumption that retaining the patient’s femoral head is beneficial. The Swedish Hip Arthroplasty Register records total hip arthroplasties since 1979 and hemiarthroplasties since 2005. All hospitals performing arthroplasty surgery in Sweden are participating and completeness of recordings is near 100 %. In a study based on data from the Swedish Hip Arthroplasty Register, patients with fracture-related total hip arthroplasty had a higher revision rate than those treated for other reasons (mainly osteoarthritis); 4.4 % compared to 2.9 % at 7 years. Revision rates were similar after acute fracture procedures and procedures performed secondary to failed internal fixation. Contrasting, hemiarthroplasties in the Swedish Hip Arthroplasty Register performed secondary to failed internal fixation were associated with a doubled risk of re-operation compared to those performed for acute fracture. Anterolateral surgical approach had a lower risk of total hip arthroplasty revision regardless of reason and hemiarthroplasty re-operation due to dislocation. Bipolar and uncemented hemiarthroplasties were risk factors for re-operation; the former due to dislocation, infection and periprosthetic fracture, the latter mainly due to periprosthetic fracture. Males had higher risk of total hip arthroplasty revision and hemiarthroplasty re-operation as well as higher risk of death within one year following the injury. Nationwide, the proportion of hemiarthroplasty procedures for acute fractures increased from 2005 through 2009 at the expense of those secondary to failed internal fixation. Use of monoblock type implants decreased to below 1 %. Modular implants increased generally, while in 2009 bipolar implants decreased in favor of unipolar. Uncemented implants and posterior surgical approach decreased. Assumedly, those changes are results of reports from clinical trials and the Swedish Hip Arthroplasty Register. In collaboration between the Swedish Hip Arthroplasty Register and the National Hip Fracture Register, all Swedish patients with displaced femoral neck fractures during 2009 received a mailed patient-reported outcomes questionnaire (79 % response rate). Patients above 70 years, with total hip arthroplasty reported less pain and were more satisfied than those treated with internal fixation or hemiarthroplasty at a median of 14 months after the fracture. Among patients below 70, those treated with total hip arthroplasty had less pain and were more satisfied than those with internal fixation. The results presented in this thesis support the use of arthroplasty as primary treatment for displaced femoral neck fractures and indicate that use of total hip arthroplasties could be increased even further. The higher risk of re-operation with bipolar implants implies that unipolar hemiarthroplasty may be preferable for the oldest. Finally, the results suggests that anterolateral surgical approach and cemented implants are preferable in fracture-related arthroplasty surgery.
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| 5. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- 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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| 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: 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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| 10. |
- 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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| 11. |
- Rogmark, Cecilia, et al.
(författare)
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Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients.
- 2016
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Ingår i: The Bone & Joint Journal. - 2049-4408. ; 98-B:3, s. 291-297
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Forskningsöversikt (refereegranskat)abstract
- This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases. TAKE HOME MESSAGE: There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group.
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| 12. |
- Rogmark, Cecilia, et al.
(författare)
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Monoblock hemiarthroplasties for femoral neck fractures - A part of orthopaedic history? Analysis of national registration of hemiarthroplasties 2005-2009.
- 2012
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Ingår i: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383. ; 43:6, s. 946-949
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Tidskriftsartikel (refereegranskat)abstract
- This study from the Swedish Hip Arthroplasty Register (SHAR) compares cemented (Thompson(®), Exeter Trauma Stem (ETS)(®)) and uncemented (Austin-Moore(®)) monoblock hemiarthroplasties (n=1116 and 616, respectively) with modular ones (n=18,659). Austin-Moore(®) prostheses lead to more re-operations (6.7%) compared to modular implants (3.5%) and Thompson(®)/ETS(®) (2.4%). A Cox regression analysis, adjusting for other risk factors, shows twice the risk of re-operation for Austin-Moore(®) implants (CI 1.5-2.8), in particular, due to periprosthetic fracture (5.4; CI 3.2-9.1) and dislocation (1.9; CI 1.3-3.0). The Thompson(®)/ETS(®) implants do not influence the overall risk of re-operation (0.7; CI 0.5-1.2) compared to modular implants and decrease the risk of re-operation due to infection (0.2;CI 0.04-0.7). An increased risk of re-operation is also seen in men, age groups 75-85 years and <75 years and after secondary fracture surgery. Both Swedish and Australian orthopaedic surgeons have decreased their use of Austin-Moore(®) implants after reports from their national arthroplasty registers identifying inferior outcome for this implant. Due to the increased risk of re-operations, it should not be used in modern orthopaedic care. Cemented Thompson(®) or ETS(®) implants could still be suitable for the oldest, low-activity patients. To finally decide if there is a place for them, patient-reported outcome must be analysed as well.
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| 13. |
- Rogmark, Cecilia, et al.
(författare)
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Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients.
- 2014
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:1, s. 18-25
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Tidskriftsartikel (refereegranskat)abstract
- Background Hemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden. Material and methods A common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals > 60 years of age treated with modular hemiarthroplasties were reported for the period 2005-2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume). Results 1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7 (SD 1.7) years. In patients over 85 years, an increased risk of reoperation was found for uncemented stems (HR = 2.2, 95% CI: 1.7-2.8), bipolar heads (HR = 1.4, CI: 1.2-1.8), posterior approach (HR = 1.4, CI: 1.2-1.8) and male sex (HR = 1.3, CI: 1.0-1.6). For patients aged 75-85 years, uncemented stems (HR = 1.6, 95% CI: 1.2-2.0) and men (HR = 1.3, CI: 1.1-1.6) carried an increased risk. Increased risk of reoperation due to infection was found for patients aged < 75 years (HR = 1.5, CI: 1.1-2.0) and for uncemented stems. For open surgery due to dislocation, the strongest risk factor was a posterior approach (HR = 2.2, CI: 1.8-2.6). Uncemented stems in particular (HR = 3.6, CI: 2.4-5.3) and male sex increased the risk of periprosthetic fracture surgery. Interpretation Cemented stems and a direct lateral transgluteal approach reduced the risk of reoperation after hip fractures treated with hemiarthroplasty in patients over 75 years. Men and younger patients had a higher risk of reoperation. For the age group 60-74 years, there were no such differences in risk in this material.
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