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International Orthopaedics

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01-08-2014 | Original Paper

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Authors: Markus T. Hongisto, Harri Pihlajamäki, Seppo Niemi, Maria Nuotio, Pekka Kannus, Ville M. Mattila

Published in: International Orthopaedics | Issue 8/2014

Abstract

Purpose

For femoral neck fractures, recent scientific evidence supports cemented hemiarthroplasty (HA) over uncemented HA and suggests that total hip arthroplasty (THA) should be performed more frequently. We report the current surgical trends in treating femoral neck fractures in Finland.

Methods

The study was conducted using the Finnish National Hospital Discharge Register and included all Finns at least 50 years of age who underwent surgery for femoral neck fractures from 1998 through 2011. Age- and sex-specific incidence rates and annual proportion of each treatment method were calculated.

Results

During 1998–2011, a total of 49,514 operations for femoral neck fracture were performed in Finland. The proportion of uncemented HA increased from 8.1 % in 2005 to 22.2 % in 2011. During the same time, the proportion of cemented HA decreased from 63.9 to 52.5 %, internal fixation decreased from 23.2 to 16.1 % and THA increased from 4.9 to 9.2 %.

Conclusions

Between 2005 and 2011, the proportion of uncemented HA for femoral neck fractures increased markedly in Finland, while cemented HA and internal fixation declined. During this time, the use of THA nearly doubled. The current evidence-based guidelines for treatment of femoral neck fractures were mainly followed, but the increase in uncemented HA procedures contradicts recent scientific evidence.

Diamantopoulos AP, Hoff M, Skoie IM et al (2013) Short- and long-term mortality in males and females with fragility hip fracture in Norway. A population-based study. Clin Interv Aging 8:817–823. doi:10.2147/CIA.S45468 PubMedCentralPubMedCrossRef

Nikitovic M, Wodchis WP, Krahn MD, Cadarette SM (2013) Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporos Int 24:659–669. doi:10.1007/s00198-012-2034-6 PubMedCentralPubMedCrossRef

Korhonen N, Niemi S, Parkkari J et al (2013) Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int 24:1599–1603. doi:10.1007/s00198-012-2190-8 PubMedCrossRef

Lönnroos E, Kautiainen H, Karppi P et al (2006) Increased incidence of hip fractures. A population based-study in Finland. Bone 39:623–627. doi:10.1016/j.bone.2006.03.001 PubMedCrossRef

Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 43:647–666

Bentley G (1980) Treatment of nondisplaced fractures of the femoral neck. Clin Orthop Relat Res 152:93–101PubMed

Holmberg S, Kalén R, Thorngren KG (1987) Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes. Clin Orthop Relat Res 218:42–52PubMed

Conn KS, Parker MJ (2004) Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res 421:249–254PubMedCrossRef

Parker MJ, White A, Boyle A (2008) Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury 39:791–795. doi:10.1016/j.injury.2008.01.011 PubMedCrossRef

10.

Rogmark C, Johnell O (2006) Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop 77:359–367. doi:10.1080/17453670610046262 PubMedCrossRef

11.

Waaler Bjørnelv GM, Frihagen F, Madsen JE et al (2012) Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporos Int 23:1711–1719. doi:10.1007/s00198-011-1772-1 PubMedCrossRef

12.

Parker MI, Pryor G, Gurusamy K (2010) Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: a randomised controlled trial in 400 patients. J Bone Joint Surg Br 92:116–122. doi:10.1302/0301-620X.92B1.22753 PubMedCrossRef

13.

Taylor F, Wright M, Zhu M (2012) Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am 94:577–583. doi:10.2106/JBJS.K.00006 PubMed

14.

DeAngelis JP, Ademi A, Staff I, Lewis CG (2012) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma 26:135–140. doi:10.1097/BOT.0b013e318238b7a5 PubMedCrossRef

15.

Lowe JA, Crist BD, Bhandari M, Ferguson TA (2010) Optimal treatment of femoral neck fractures according to patient’s physiologic age: an evidence-based review. Orthop Clin North Am 41:157–166. doi:10.1016/j.ocl.2010.01.001 PubMedCrossRef

16.

Burgers PTPW, Van Geene AR, Van den Bekerom MPJ et al (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop 36:1549–1560. doi:10.1007/s00264-012-1569-7 PubMedCentralPubMedCrossRef

17.

Yu L, Wang Y, Chen J (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res 470:2235–2243. doi:10.1007/s11999-012-2293-8 PubMedCentralPubMedCrossRef

18.

Mattila VM, Sillanpää P, Iivonen T et al (2008) Coverage and accuracy of diagnosis of cruciate ligament injury in the Finnish National Hospital Discharge Register. Injury 39:1373–1376. doi:10.1016/j.injury.2008.05.007 PubMedCrossRef

19.

Sund R (2012) Quality of the Finnish Hospital Discharge Register: a systematic review. Scand J Public Health 40:505–515. doi:10.1177/1403494812456637 PubMedCrossRef

20.

Parvizi J, Holiday AD, Ereth MH, Lewallen DG (1999) The Frank Stinchfield Award. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res 369:39–48PubMedCrossRef

21.

Figved W, Opland V, Frihagen F et al (2009) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 467:2426–2435. doi:10.1007/s11999-008-0672-y PubMedCentralPubMedCrossRef

22.

Hedbeck C-J, Inngul C, Blomfeldt R et al (2013) Internal fixation versus cemented hemiarthroplasty for displaced femoral neck fractures in patients with severe cognitive dysfunction: a randomized controlled trial. J Orthop Trauma 27:690–695. doi:10.1097/BOT.0b013e318291f544 PubMedCrossRef

23.

Støen RØ, Lofthus CM, Nordsletten L et al (2014) Randomized trial of hemiarthroplasty versus internal fixation for femoral neck fractures: no differences at 6 years. Clin Orthop Relat Res 472:360–367. doi:10.1007/s11999-013-3245-7 PubMedCrossRef

24.

Bjørgul K, Reikerås O (2006) Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: a prospective study of 683 patients treated with hemiarthroplasty or internal fixation. Acta Orthop 77:368–374. doi:10.1080/17453670610046271 PubMedCrossRef

25.

Inngul C, Hedbeck C-J, Blomfeldt R et al (2013) Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial. Int Orthop 37:2457–2464. doi:10.1007/s00264-013-2117-9 PubMedCrossRef

26.

Parker MJ, Gurusamy KS, Azegami S (2010) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 6:CD001706. doi:10.1002/14651858.CD001706.pub4

27.

Luo X, He S, Li Z, Huang D (2011) Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg 132:455–463. doi:10.1007/s00402-011-1436-9 PubMedCrossRef

28.

Li T, Zhuang Q, Weng X et al (2013) Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PLoS One 8:e68903. doi:10.1371/journal.pone.0068903 PubMedCentralPubMedCrossRef

29.

Langslet E, Frihagen F, Opland V et al (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res 472:1291–1299. doi:10.1007/s11999-013-3308-9 PubMedCrossRef

30.

Bensen AS, Jakobsen T, Krarup N (2014) Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. Int Orthop. doi:10.1007/s00264-013-2276-8 PubMed

31.

Upadhyay A, Jain P, Mishra P et al (2004) Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint Surg Br 86:1035–1040PubMedCrossRef

32.

Hedström M (2004) Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment? A pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures. Acta Orthop Scand 75:50–52PubMedCrossRef

33.

Murphy DK, Randell T, Brennan KL et al (2013) Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res 471:2691–2702. doi:10.1007/s11999-013-3020-9 PubMedCrossRef

34.

Dai Z, Li Y, Jiang D (2011) Meta-analysis comparing arthroplasty with internal fixation for displaced femoral neck fracture in the elderly. J Surg Res 165:68–74. doi:10.1016/j.jss.2009.03.029 PubMedCrossRef

35.

Viberg B, Overgaard S, Lauritsen J, Ovesen O (2013) Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture: 12- to 19-year follow-up of patients aged 75 years or more. Acta Orthop 84:254–259. doi:10.3109/17453674.2013.792033 PubMedCentralPubMedCrossRef

Title: Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011
Authors: Markus T. Hongisto
Harri Pihlajamäki
Seppo Niemi
Maria Nuotio
Pekka Kannus
Ville M. Mattila
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-014-2346-6

At a glance: The STEP trials

Springer Medicine

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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