Trends in hemiarthroplasty and total hip arthroplasty for femoral neck fractures: Surgeon or patient driven?

IF 2 3区 医学 Q3 CRITICAL CARE MEDICINE
Christina Liu , Stephen Moye , Austin T. Gregg , Thirushan Wignakumar , Adriana Liimakka , Yibin Zhang , Alex Farid , Antonia F. Chen , Nishant Suneja
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Abstract

Introduction

The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.

Methods and materials

Design: Retrospective cohort.
Setting: Two Level 1 Trauma Centers.
Patient Selection Criteria: Adult patients with FNFs between 2001 and 2023.

Results

A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, p < 0.001) and more likely to be female (70.9 % vs. 65.1 %, p = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m2, p = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, p < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, p < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, p < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, p < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, p < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, p < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, p = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, p = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, p < 0.001) and 1 year (21.1 % vs. 3.8 %, p < 0.001) mortality rates.

Conclusions

There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.
股骨颈骨折半髋关节置换术和全髋关节置换术的趋势:外科医生还是患者驱动?
主要目的是分析过去二十年来成人骨折患者(FNFs)的半髋关节置换术(HA)和全髋关节置换术(THA)的趋势,重点是老年人群。次要目的是比较HA和THA之间的结果,并评估其与患者和外科医生特异性因素的关系。方法与材料设计:回顾性队列研究。环境:两个一级创伤中心。患者选择标准:2001年至2023年间患有fnf的成年患者。结果本研究共纳入3180例经关节置换术治疗的FNF,其中HA 2497例,THA 683例。老年FNFs的全髋关节置换术和全髋关节置换术的总体增加,其中全髋关节置换术的增加速度更快(分别为223%和172%)。接受THA的患者更年轻(70.8岁对81.4岁,p < 0.001),女性更有可能(70.9%对65.1%,p = 0.006)。接受HA治疗的患者BMI较低(24.6对25.4kg/m2, p = 0.002), Charlson合并症指数较高(7.5对4.6,p < 0.001),痴呆率较高(29.9%对7.8%,p < 0.001)。与选择THA而非HA相关的因素包括关节成形术培训(21.5%对10.4%,p < 0.001)和更丰富的手术经验(以实践年数衡量)(15.1%对12.5年,p < 0.001)。接受THA治疗的患者住院时间较短(6.3天对7.9天,p < 0.001),出院回家的可能性更大(24.3%对5.5%,p < 0.001)。尽管再手术率相似(4.5%对5.1%,p = 0.58), THA导致更高的并发症发生率(9.2%对6.1%,p = 0.006)。HA的90天死亡率(11.1% vs. 1.6%, p < 0.001)和1年死亡率(21.1% vs. 3.8%, p < 0.001)较高。结论在过去的二十年中,全髋关节置换术治疗fnf的趋势呈上升趋势,影响治疗决策的因素是患者和外科医生共同驱动的。
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
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