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BMC Musculoskeletal Disorders

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Open Access 01-12-2024 | Hip-TEP | Research

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Authors: Zahra Al-Essah, Keegan Curlewis, Gareth Chan, Karim Tokeisham, Koushik Ghosh, Philip Stott, Benedict A. Rogers

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

Abstract

Background

Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians.

Methods

A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 – 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination.

Results

There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015).

Conclusion

There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds.

Trial registration

Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.

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Title: Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians
Authors: Zahra Al-Essah
Keegan Curlewis
Gareth Chan
Karim Tokeisham
Koushik Ghosh
Philip Stott
Benedict A. Rogers
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Hip-TEP
Hip-TEP
Periprosthetic Fracture
Published in: BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-024-07340-1

At a glance: The STEP trials

Springer Medicine

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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