Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
entrez:
7
10
2020
pubmed:
8
10
2020
medline:
22
6
2021
Statut:
ppublish
Résumé
To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). Retrospective cohort study. Secondary data analysis of 2 multinational randomized controlled trials. Patients aged 50 years or older with a FNF. Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 33027160
doi: 10.1097/BOT.0000000000001940
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
S9-S14Investigateurs
Mohit Bhandari
(M)
Marc Swiontkowski
(M)
P J Devereaux
(PJ)
Gordon Guyatt
(G)
Martin J Heetveld
(MJ)
Kyle Jeray
(K)
Susan Liew
(S)
Martin Richardson
(M)
Emil H Schemitsch
(EH)
Lehana Thabane
(L)
Paul Tornetta
(P)
Stephen D Walter
(SD)
Mohit Bhandari
(M)
Sheila Sprague
(S)
Paula McKay
(P)
Taryn Scott
(T)
Alisha Garibaldi
(A)
Helena Viveiros
(H)
Marilyn Swinton
(M)
Mark Gichuru
(M)
Sofia Bzovsky
(S)
Diane Heels-Ansdell
(D)
Qi Zhou
(Q)
Lisa Buckingham
(L)
Aravin Duraikannan
(A)
Deborah Maddock
(D)
Nicole Simunovic
(N)
Marc Swiontkowski
(M)
Julie Agel
(J)
Martin J Heetveld
(MJ)
Esther M M Van Lieshout
(EMM)
Stephanie M Zielinski
(SM)
Amar Rangan
(A)
Birgit C Hanusch
(BC)
Lucksy Kottam
(L)
Rachel Clarkson
(R)
Gregory J Della Rocca
(GJ)
Robert Haverlag
(R)
Susan Liew
(S)
Gerard P Slobogean
(GP)
Kyle Jeray
(K)
Robert McCormack
(R)
Kelly Apostle
(K)
Dory Boyer
(D)
Farhad Moola
(F)
Bertrand Perey
(B)
Trevor Stone
(T)
Darius Viskontas
(D)
H Michael Lemke
(HM)
Mauri Zomar
(M)
Karyn Moon
(K)
Raely Moon
(R)
Amber Oatt
(A)
Richard E Buckley
(RE)
Paul Duffy
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Robert Korley
(R)
Shannon Puloski
(S)
James Powell
(J)
Kelly Johnston
(K)
Kimberly Carcary
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Melissa Lorenzo
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Ross McKercher
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David Sanders
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Mark MacLeod
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Abdel-Rahman Lawendy
(AR)
Christina Tieszer
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David Stephen
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Hans Kreder
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Richard Jenkinson
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