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Multicenter Study
. 2014 Feb;85(1):18-25.
doi: 10.3109/17453674.2014.885356. Epub 2014 Jan 24.

Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients

Cecilia Rogmark  1 , Anne M Fenstad, Olof Leonardsson, Lars B Engesæter, Johan Kärrholm, Ove Furnes, Göran Garellick, Jan-Erik Gjertsen
Affiliations
Multicenter Study

Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients

Cecilia Rogmark et al. Acta Orthop. 2014 Feb.

Abstract

Background: Hemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden.

Material and methods: A common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals > 60 years of age treated with modular hemiarthroplasties were reported for the period 2005-2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume).

Results: 1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7 (SD 1.7) years. In patients over 85 years, an increased risk of reoperation was found for uncemented stems (HR = 2.2, 95% CI: 1.7-2.8), bipolar heads (HR = 1.4, CI: 1.2-1.8), posterior approach (HR = 1.4, CI: 1.2-1.8) and male sex (HR = 1.3, CI: 1.0-1.6). For patients aged 75-85 years, uncemented stems (HR = 1.6, 95% CI: 1.2-2.0) and men (HR = 1.3, CI: 1.1-1.6) carried an increased risk. Increased risk of reoperation due to infection was found for patients aged < 75 years (HR = 1.5, CI: 1.1-2.0) and for uncemented stems. For open surgery due to dislocation, the strongest risk factor was a posterior approach (HR = 2.2, CI: 1.8-2.6). Uncemented stems in particular (HR = 3.6, CI: 2.4-5.3) and male sex increased the risk of periprosthetic fracture surgery.

Interpretation: Cemented stems and a direct lateral transgluteal approach reduced the risk of reoperation after hip fractures treated with hemiarthroplasty in patients over 75 years. Men and younger patients had a higher risk of reoperation. For the age group 60-74 years, there were no such differences in risk in this material.

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Survival analysis of bipolar and unipolar implants in the age group 60–74 years.
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