Top

International Orthopaedics

Published in:

01-01-2012 | Review Article

Arthroplasty options in femoral-neck fracture: answers from the national registries

Authors: Arun Kannan, Ramprasad Kancherla, Stephen McMahon, Gabrielle Hawdon, Aditya Soral, Rajesh Malhotra

Published in: International Orthopaedics | Issue 1/2012

Abstract

Purpose

Femoral-neck fracture in the elderly population is a problem that demands the attention of the orthopaedic community as life expectancy continues to increase. There are several different treatment options in use, and this variety in and of itself indicates the absence of an ideal single treatment option. Recent debate has focussed on the probable superiority of total hip arthroplasty (THA) over hemiarthroplasty for femoral-neck fracture. Clinical trials and systematic reviews of such trials have not provided a convincing answer to this question.

Methods

We analysed data from national registries evaluating prosthetic replacements for femoral-neck fracture in the elderly. We compared revision and reoperation rates of hemiarthroplasty and THA, analysed the prognostic variables that influenced implant survival and the major causes of failure.

Results

Data from the Australian and Italian registries indicate that THA has an increased revision rate compared with bipolar hemiarthroplasty in femoral-neck fracture in the elderly. The registries identify that age over 75 years and the use of the anterior surgical approach are associated with better survivorship in patients who have a hemiarthroplasty. Cemented fixation of the femoral stem in hemiarthroplasty and THA is supported by registry data. Acetabular erosion accounted for a very low percentage of hemiarthroplasty revisions and reoperations.

Conclusion

Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival.

Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289PubMedCrossRef

Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001PubMed

Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH (2005) Operative management of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am 87(9):2122–2130PubMedCrossRef

van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonk EH, Goslings JC, van Dijk CN, Raaymakers EL (2010) A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br 92(10):1422–1428PubMedCrossRef

Macaulay W, Nellans KW, Garvin KL, Iorio R, Healy WL, Rosenwasser MP (2008) Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr award. J Arthroplasty 23:2–8PubMedCrossRef

Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2006) Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty, Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 88:249–260PubMedCrossRef

Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomised study. Injury 31:793–797PubMedCrossRef

Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B (1989) Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. Injury 20:291–293PubMedCrossRef

Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a randomized, controlled trial. J Bone Joint Surg Am 88:2583–2589PubMedCrossRef

10.

Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J (2007) A randomized controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 89:160–165PubMedCrossRef

11.

Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R (1986) Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1:21–28PubMedCrossRef

12.

Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G, Batanis G, Tsembeli A et al (2008) The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. Int Orthop 32:367–373PubMedCrossRef

13.

Parker MJ, Gurusamy KS, Azegami S (2010) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 16(6):CD001706

14.

Hopley C, Stengel D, Ekkernkamp A, Wich M (2010) Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 11(340):c2332–c2332CrossRef

15.

Australian Orthopaedic Association Web site. National Joint Replacement Registry Annual Report 2010. Available at: www.dmac.adelaide.edu.au/aoanjrr/. Accessed January 9, 2011

16.

Swedish Hip Arthroplasty Register Annual Report 2009. Available at: www.jru.orthop.gu.se. Accessed January 9, 2011

17.

National Joint Registry for England and Wales. Seventh Annual Report 2010. Available at: www.njrcentre.org.uk. Accessed January 9, 2011

18.

The National Hip Fracture Database National Report 2010. Available at http://www.njrcentre.org.uk/njrcentre/default.aspx. Accessed January 9, 2011

19.

Australian Orthopaedic Association National Joint Replacement Registry. Accessed February 11, 2011 (Unpublished data provided on request)

20.

Register of the Orthopaedic Prosthetic Implants, Emilia Romagna, Italy. Accessed July 4, 2011 (Unpublished data provided on request)

21.

Varley J, Parker MJ (2004) Stability of hip hemiarthroplasties. Int Orthop 28:274–277PubMedCrossRef

Title: Arthroplasty options in femoral-neck fracture: answers from the national registries
Authors: Arun Kannan
Ramprasad Kancherla
Stephen McMahon
Gabrielle Hawdon
Aditya Soral
Rajesh Malhotra
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 1/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-011-1354-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Arthroplasty options in femoral-neck fracture: answers from the national registries

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2012

Biphasic bone substitute and fibrin sealant for treatment of benign bone tumours and tumour-like lesions

Analysis of synovial fluid in knee joint of osteoarthritis:5 proteome patterns of joint inflammation based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents

Impact of close surgical margin on local recurrence and survival in osteosarcoma

Thrombo-prophylaxis in pelvic and acetabular trauma patients: a UK consensus?

Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable?