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The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
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2006 (Engelska)Ingår i: International Orthopaedics, ISSN 0341-2695, Vol. 30, nr 1, s. 1-6Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

We randomised 143 patients –age 75 years or older–with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

Ort, förlag, år, upplaga, sidor
2006. Vol. 30, nr 1, s. 1-6
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-13731DOI: 10.1007/s00264-005-0037-zOAI: oai:DiVA.org:liu-13731DiVA, id: diva2:21219
Tillgänglig från: 2002-05-12 Skapad: 2002-05-12
Ingår i avhandling
1. Displaced Femoral Neck Fractures: A prospective randomized study of clinical outcome, nutrition and costs
Öppna denna publikation i ny flik eller fönster >>Displaced Femoral Neck Fractures: A prospective randomized study of clinical outcome, nutrition and costs
2002 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Displaced femoral neck fractures comprise more than a third of all hip fractures. There is controversy as to the optimal treatment. Despite attempts to improve the methods for internal fixation, complication rates have been almost unchanged: 20-40% non-union and late segmental collapse in another 10-20%. Internal fixation has been the preferred treatment in Scandinavia, whereas primary hemi- or total arthroplasty have been more prevalent in the rest of Europe and North America.

In this study, patients 75 years or older, including those with mental impairment, were randomized to either internal fixation or cemented primary total hip arthroplasty (THA). A total of 146 hips in 143 patients were followed for two years. After one year 23% had died, and after two years 29%. Mortality was about the same in both groups. The accumulated mortality was pronounced among the mentally impaired patients.

In the internal fixation group, 44% underwent further surgery. In the THA group, 18% dislocated. The dislocation rate was higher for the mentally impaired patients. The Harris hip scores were higher in the THA group, whereas pain was more common in the internal fixation group.

The first 50 patients in each treatment group were studied concerning heterotopic ossification (HO), a well-known complication after THA. The incidence of HO in the THA group was similar to what is found after THA due to osteoarthritis. However, only 1/39 developed severe symptoms.

A subgroup of 100 patients was included in a study concerning nutritional status and functional capacity using the Modified Norton scale, Katz index of ADL and a questionnaire measuring instrumental activities of daily living. The THA group fared better concerning weight change over time, locomotion and pain. The nutritional intervention did not show any measurable effects.

All patients were followed until two years postoperatively and all fracturerelated hospital costs, including reoperations, were calculated. We found no difference in total costs between the treatment groups. Costs to the municipality were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups.

On the basis of our results, we recommend arthroplasty for patients in this age group with normal mental function and high functional demands.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2002. s. 55
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 731
Nyckelord
Arthroplasty, replacement, hip, adverse effects, economics, fracture fixation, internal, femoral neck fractures, surgery, ossification, heterotropic, etiology, nutritional support
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:liu:diva-5233 (URN)91-7373-180-3 (ISBN)
Disputation
2002-05-17, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2002-05-12 Skapad: 2002-05-12 Senast uppdaterad: 2012-01-25Bibliografiskt granskad

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Johansson, TorstenBachrach-Lindström, MargaretaAspenberg, PerJonsson, DickWahlström, Ola

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Ortopedi och idrottsmedicinHälsouniversitetetOmvårdnadMedicinsk teknologiutvärdering
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