Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Původní práce / Original papers

ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL.,
84, 2017, p. 341 - 346

Cemented Hemiarthroplasties Are Associated with a Higher Mortality Rate after Femoral Neck Fractures in Elderly Patients

Cementované hemiartroplastiky u zlomenin krčku femuru starších pacientů jsou spojeny s vyšší úmrtností

M. FUCHS1,2, F. A. SASS2,3, S. DIETZE1, M. KRÄMER4, C. PERKA1, M. MÜLLER1
1 Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Berlin, Germany
2 Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, Julius Wolff Institute, Berlin, Germany
3 Charité - Universitätsmedizin Berlin, Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
4 Charité - Universitätsmedizin Berlin, Department of Anaesthesiology and Intensive Care, Berlin, Germany

ABSTRACT

PURPOSE OF THE STUDY

The postoperative outcomes of total hip replacement and hemiarthroplasty after femoral neck fractures in elderly patients were analysed to determine general and local complications as well as morbidity and mortality rates in order to detect risk profiles and assess the best individual treatment option.

MATERIALS AND METHODS

One hundred sixty-one femoral neck fractures among patients aged > 65 years treated with cemented hemiarthroplasty (HA) or uncemented total hip arthroplasty (THA) between January 2005 and October 2013 were evaluated. In the presence of articular pathologies as well as a fracture type Garden III or IV, the indication for joint replacement was given. Criteria for performing hemiarthroplasty were previously limited mobility. Freely and fully mobilised patients and patients with manifested osteoarthritis received a cementless THA. A comparison of the observed complications was made, differentiating between general and surgery-specific hip-related complications. Furthermore, the mortality rates were analysed in relation to the respective surgical treatment.

RESULTS

Seventy cemented HA and ninety-one uncemented THA were performed. There was a  high complication rate of approximately 19% in both surgical intervention groups. The patients were more likely to develop general complications (HA 12.8%; THA 10.8%) even though cardiopulmonary complications occurred more frequently in the cemented HA group. Four patients died after cemented hemiarthroplasty due to thromboembolic events (5.7% mortality rate), whereas no deaths occurred after total hip replacement. Surgery-specific complications rates were 7.8% in THA and 5.7% in HA patients.

CONCLUSIONS

THA in eldery patients with femoral neck fractures is associated with a higher complication rate, mostly of general medical entity. After cemented HA, our study reveals a high mortality rate due to thromboembolic events. For patients with multimorbidity in particular, these findings therefore suggest that uncemented THA should be considered to prevent lethal complications.

Key words: femoral neck fracture; total hip arthroplasty; hemiarthroplasty; complications

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