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Displaced Femoral Neck Fractures: A prospective randomized study of clinical outcome, nutrition and costs
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.
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 [en]
Arthroplasty, replacement, hip, adverse effects, economics, fracture fixation, internal, femoral neck fractures, surgery, ossification, heterotropic, etiology, nutritional support
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-5233ISBN: 91-7373-180-3 (print)OAI: oai:DiVA.org:liu-5233DiVA: diva2:21220
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
List of papers
1. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures
Open this publication in new window or tab >>Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures
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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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13728 (URN)
Available from: 2002-05-12 Created: 2002-05-12 Last updated: 2009-08-19
2. Heterotopic bone formation following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study
Open this publication in new window or tab >>Heterotopic bone formation following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study
2001 (English)In: International Orthopaedics, ISSN 0341-2695, Vol. 25, no 4, 223-225 p.Article in journal (Refereed) Published
Abstract [en]

One hundred hips in 99 patients of 75 years or older, with a displaced femoral neck fracture, were studied for heterotopic ossification (HO). The patients were randomized to either internal fixation or total hip arthroplasty (THA). In the THA group HO was found in 32 of 45 hips compared with 1 of 39 in the internal fixation group (P<0.0012). The frequency of HO after THA corresponds well with findings in other studies on patients receiving THA for osteoarthrosis. In cervical fractures the surgical procedure of total hip replacement seems to be a prerequisite for HO, indicating that the procedure itself is more important than the patient's age and the diagnosis. Severe symptoms due to HO were found in only one patient. HO following THA for a femoral neck fracture is of little clinical importance and prophylaxis is unnecessary.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13729 (URN)10.1007/s002640100263 (DOI)
Available from: 2002-05-12 Created: 2002-05-12 Last updated: 2009-08-19
3. Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study
Open this publication in new window or tab >>Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study
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2000 (English)In: Aging, ISSN 1945-4589, E-ISSN 1945-4589, Vol. 12, no 5, 366-374 p.Article in journal (Refereed) Published
Abstract [en]

The primary aim of this study was to evaluate the effect of two different surgical methods on nutritional status and functional capacity during the first postoperative year in patients with displaced femoral neck fractures. A further aim was to evaluate the effect of nutritional support. One hundred patients were randomly assigned to treatment with either primary total hip arthroplasty (THA) or osteosynthesis. Half of the patients in each treatment group received protein- and energy-enriched food in the hospital in addition to individual nutritional advice in order to optimize their intake of protein- and energy-rich food. Nutritional state and functional capacity were examined at baseline, one and three months, and one year after the operation. Pain was examined at three months and one year. The effect of nutritional intervention was equal within both surgical groups. Logistic regression showed that the dependent variable "living at one year" was significantly associated with serum albumin levels at one month. Advanced age, mental impairment and deteriorated nutritional status were predominant in the non-survivors. Overall, the primary THA group performed better compared with the osteosynthesis group concerning weight change over time, locomotion and pain. This study also showed that primary THA could safely be performed in the elderly without an increased postoperative mortality rate.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13730 (URN)11126523 (PubMedID)
Available from: 2002-05-12 Created: 2002-05-12 Last updated: 2017-12-13Bibliographically approved
4. The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips
Open this publication in new window or tab >>The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips
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2006 (English)In: International Orthopaedics, ISSN 0341-2695, Vol. 30, no 1, 1-6 p.Article in journal (Refereed) 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13731 (URN)10.1007/s00264-005-0037-z (DOI)
Available from: 2002-05-12 Created: 2002-05-12

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