Itay Ron, Yakov Tkatch, David Shaked Zari, Mosa Shhade, Noam Reshef, Utai Rudich, Alexander Lerner, Jacob Shapira
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引用次数: 0
Abstract
Background: Total hip arthroplasty (THA) and hemiarthroplasty (HA) are established treatments for displaced femoral neck fractures (FNF), yet factors associated with revision following either procedure remain poorly defined. This study evaluated demographic, clinical, and laboratory predictors of revision after THA and HA for FNF.
Methods: A retrospective cohort study was conducted at a tertiary trauma centre including 2,522 patients treated with arthroplasty for FNF (885 THA, 1,637 HA). Demographic characteristics, comorbidities, and pre- and postoperative laboratory parameters were compared between patients who underwent revision and those who did not. Variables significant on univariate analysis were entered into multivariable logistic regression. Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values for significant continuous predictors.
Results: Revision occurred in 93 of 885 THA patients (10.5%) and 43 of 1,637 HA patients (2.6%) (p < 0.001). In the THA cohort, patients requiring revision were younger (65.4 vs. 72.5 years, p < 0.001), had shorter hospital stays (5.4 vs. 7.5 days, p = 0.001), higher postoperative haemoglobin (10.5 vs. 9.6 g/dL, p < 0.001), and lower postoperative C-reactive protein (CRP) levels (10.8 vs. 15.7 mg/dL, p = 0.007). Multivariable analysis identified younger age (OR 0.94 per year, 95% CI 0.91-0.98; p = 0.003), higher postoperative haemoglobin (OR 1.29, 95% CI 1.01-1.66; p = 0.044), and lower postoperative CRP (OR 0.94, 95% CI 0.90-0.99; p = 0.029) as independent predictors of revision. ROC analysis identified age < 60 years (AUC 0.66) and postoperative haemoglobin ≥ 10.55 g/dL (AUC 0.63) as optimal thresholds. In the HA cohort, only postoperative lymphocyte count differed significantly between revision and non-revision groups, precluding multivariable analysis.
Conclusions: Revision following arthroplasty for femoral neck fracture was substantially more common after THA than HA. Among THA patients, revision was associated with younger age and markers of better postoperative physiological recovery rather than medical frailty. These findings suggest that revision risk after fracture-related THA may largely reflect the greater activity level and longer survivorship of healthier patients, information that may assist preoperative counseling and individualized procedure selection.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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