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. 2023 Aug 1;105-B(8):864-871.
doi: 10.1302/0301-620X.105B8.BJJ-2022-1150.R3.

Long-term implant survival following hemiarthroplasty for fractured neck of femur

Ben Tyas  1 , Martin Marsh  2 , Richard de Steiger  3   4 , Michelle Lorimer  4 , Timothy G Petheram  5 , Dominic S Inman  5 , Mike R Reed  5 , Simon S Jameson  6
Affiliations

Long-term implant survival following hemiarthroplasty for fractured neck of femur

Ben Tyas et al. Bone Joint J. .

Abstract

Aims: Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term data are lacking. The aim of this study was to report the ten-year implant survival of commonly used designs of hemiarthroplasty.

Methods: Patients recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) between 1 September 1999 and 31 December 2020 who underwent hemiarthroplasty for the treatment of a hip fracture with the following implants were included: a cemented monoblock Exeter Trauma Stem (ETS), cemented Exeter V40 with a bipolar head, a monoblock Thompsons prosthesis (Cobalt/Chromium or Titanium), and an Exeter V40 with a Unitrax head. Overall and age-defined cumulative revision rates were compared over the ten years following surgery.

Results: A total of 41,949 hemiarthroplasties were included. Exeter V40 with a Unitrax head was the most commonly used (n = 20,707, 49.4%). The overall rate of revision was small. A total of 28,201 patients (67.2%) were aged > 80 years. There were no significant differences in revision rates across all designs of hemiarthroplasty in patients of this age at any time. The revision rates for all designs were < 3.5%, three years postoperatively. At subsequent times the ETS and Exeter V40 with a bipolar head performed well in all age groups. The unadjusted ten-year mortality rate for the whole cohort was 82.2%.

Conclusion: There was no difference in implant survival between all the designs of hemiarthroplasty in the first three years following surgery, supporting the selection of a cost-effective design of hemiarthroplasty for most patients with an intracapsular fracture of the hip, as determined by local availability and costs. Beyond this, the ETS and Exeter bipolar designs performed well in all age groups.

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Conflict of interest statement

S. S. Jameson reports an institutional grant (paid to South Tees Hospitals NHS Foundation Trust) from Stryker, as well as payment for teaching on courses from Stryker, both not related to this study. T. G. Petheram and M. R. Reed report educational payments for teaching courses from Stryker, not related to this study, and an institutional grant (paid to Northumbria Healthcare NHS Foundation Trust for the Bone and Joint Infection Registry) from Stryker, not related to this study.

References

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    1. No authors listed . National Hip Fracture Database (NHFD) Annual Report 2019 . Royal College of Physicians . 2019 . https://www.nhfd.co.uk/20/hipfractureR.nsf/docs/reports2019 ( date last accessed 9 June 2023 ).
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