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Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease analysis of 9,638 patients from the swedish hip arthroplasty register
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- Cnudde, P. H. J. (author)
- Swedish Arthroplasty Register, Vastra Gotaland Ctr Registers, Gothenburg, Sweden.;Gothenburg Univ, Dept Orthopaed, Sahlgrenska Akad, Gothenburg, Sweden.;Hywel Dda Univ Hlth Board, Dept Orthopaed, Llanelli, Wales.,Sahlgrenska Academy
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- Natman, J. (author)
- Swedish Arthroplasty Register, Vastra Gotaland Ctr Registers, Gothenburg, Sweden.;Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
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- Hailer, Nils (author)
- Uppsala universitet,Ortopedi,Swedish Arthroplasty Register, Vastra Gotaland Ctr Registers, Gothenburg, Sweden.;Swedish Hip Arthroplasty Register, Orthopaed, Gothenburg, Sweden.,Uppsala University Hospital
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- Swedish Arthroplasty Register, Vastra Gotaland Ctr Registers, Gothenburg, Sweden;Gothenburg Univ, Dept Orthopaed, Sahlgrenska Akad, Gothenburg, Sweden.;Hywel Dda Univ Hlth Board, Dept Orthopaed, Llanelli, Wales. Sahlgrenska Academy (creator_code:org_t)
- BRITISH EDITORIAL SOC BONE & JOINT SURGERY, 2022
- 2022
- English.
- In: The Bone & Joint Journal. - : BRITISH EDITORIAL SOC BONE & JOINT SURGERY. - 2049-4394 .- 2049-4408. ; 104B:1, s. 134-141
- Journal article (peer-reviewed)
Abstract
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- Aims The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of <= 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). Results A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Conclusion Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Ortopedi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Orthopaedics (hsv//eng)
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- art (subject category)
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