Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures: a randomized long-term follow-up study

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Chammout, Ghazi Khalil (författare)

Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures : a randomized long-term follow-up study

Artikel/kapitelEngelska2012

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Journal of Bone and Joint Surgery,2012
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LIBRIS-ID:oai:DiVA.org:umu-60112
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-60112URI
https://doi.org/10.2106/JBJS.K.01615DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:125562539URI

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Språk:engelska
Sammanfattning på:engelska

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Background: Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years.Methods: We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial; all patients had had a healthy hip before the injury. The study group included seventy-nine women and twenty-one men with a mean age of seventy-eight years (range, sixty-five to ninety years). The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57). The primary end point was hip function, evaluated with use of the Harris hip score. Secondary end points included mortality, reoperations, gait speed, and activities of daily life. Follow-up evaluations were performed at threemonths and at one, two, four, eleven, and seventeen years.Results: The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95% confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period. We found no difference in mortality between the two groups. Four patients (9%) in the total hip replacement group and twenty-two patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64). The overall reoperation rate was 23% (ten of forty-three) in the total hip replacement group and 53% (thirty of fifty-seven) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80). The results related to gait speed and activities of daily living favored the arthroplasty group during the first year.Conclusions: Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Ortopedi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Orthopaedics hsv//eng
controlled trial
arthroplasty
femur
index
hemiarthroplasty
dislocation
arthritis
register
alloy
score

Biuppslag (personer, institutioner, konferenser, titlar ...)

Mukka, Sebastian SimonUmeå universitet,Ortopedi(Swepub:umu)semu0002 (författare)
Carlsson, ThomasDanderyds sjukhus (författare)
Neander, Gustaf FredrikKarolinska Institutet (författare)
Stark, André Wilhelm Helge (författare)
Sköldenberg, Olof GustafKarolinska Institutet (författare)
Umeå universitetOrtopedi (creator_code:org_t)

Sammanhörande titlar

Ingår i:Journal of Bone and Joint Surgery. American volume: Journal of Bone and Joint Surgery94:21, s. 1921-19280021-93551535-1386

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Av författaren/redakt...: Chammout, Ghazi ...; Mukka, Sebastian ...; Carlsson, Thomas; Neander, Gustaf ...; Stark, André Wil ...; Sköldenberg, Olo ...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Ortopedi

Artiklar i publikationen: Journal of Bone ...

Av lärosätet: Umeå universitet; Karolinska Institutet

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