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Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
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2000 (English)In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 71, no 6, 597-602 p.Article in journal (Refereed) Published
Abstract [en]

100 patients 75 years or older, with displaced femoral neck fractures, were randomly assigned to osteosynthesis with two parallel and percutaneously inserted screws (Olmed) or total hip arthroplasty (Lubinus IP). Mean age was 84 (75-101) years, 74% were women and 45% had mental dysfunction. General complications were commoner in the arthroplasty group but the mortality rates did not differ. In the osteosynthesis group, fracture complications were seen in 27/50 hips. In the arthroplasty group, dislocation was the main complication and occurred in 11/50 cases. At 3 months and after 1 year, the Harris Hip Scores were significantly better in the arthroplasty group. When mental dysfunction was present, the dislocation rate after arthroplasty was 32%, whereas the reoperation rate after osteosynthesis was 5%. The opposite pattern of complications was found in patients with normal mental function, 12% versus 60%. The 2-year mortality rate among those with mental dysfunction was 26/45, compared to 7/55 of those with normal function (p < 0.001). We conclude that total hip arthroplasty should be considered for a displaced femoral neck fracture in old patients with normal mental function and high functional demands.

Place, publisher, year, edition, pages
2000. Vol. 71, no 6, 597-602 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13728OAI: oai:DiVA.org:liu-13728DiVA: diva2:21216
Available from: 2002-05-12 Created: 2002-05-12 Last updated: 2009-08-19
In thesis
1. Displaced Femoral Neck Fractures: A prospective randomized study of clinical outcome, nutrition and costs
Open this publication in new window or tab >>Displaced Femoral Neck Fractures: A prospective randomized study of clinical outcome, nutrition and costs
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 55 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 731
Keyword
Arthroplasty, replacement, hip, adverse effects, economics, fracture fixation, internal, femoral neck fractures, surgery, ossification, heterotropic, etiology, nutritional support
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-5233 (URN)91-7373-180-3 (ISBN)
Public defence
2002-05-17, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2002-05-12 Created: 2002-05-12 Last updated: 2012-01-25Bibliographically approved

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Johansson, TorstenJacobsson, Sven-ArneIvarsson, IngemarWahlström, Ola

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