Abstract
To analyze the factors that affect the survivorship of subjects treated by hemiarthroplasty after a femoral neck fracture. This is a retrospective study of 1196 consecutive subcapital fractures in 1166 patients treated with a Thompson hemiarthroplasty between 1989 and 2001 for a femoral neck fracture. A clinical follow-up was made of a random sample of 220 fractures. Of these, 210 cases were followed up for at least two years or until the patients’ death (95.5%). A multivariate analysis was carried out of the effect on survivorship of age, gender, associated conditions, delay of surgery and post-op complications. Implant survivorship was also analyzed. Median survivorship was 4.5 years. Male gender had a higher mortality rate (RR = 2.47, 95% confidence interval: 1.65-3.70; p < 0.001) as did old age (RR = 1.04, CI: 1.01-1.07; p = 0.005). Although, delay of surgery did not affect long-term survivorship, it did affect survivorship at 6 months: patients operated the same day they were admitted had a higher mortality rate than those operated in the first 10 days after admission (33.3% vs. 10.4%; OR = 4.38; CI: 1.12-16.5; p = 0.03). Only three implants had to be explanted, all of them further to aseptic loosening. The factors that most significantly contribute to mortality in this group of patients are male gender, age and the presence of a disease. A 24-hour delay of surgery can increase short-term survivorship. Implants rarely fail. Analizar los factores que afectan a la supervivencia de sujetos tratados con hemiartroplastia tras una fractura subcapital de fémur. Estudio retrospectivo de 1.196 fracturas subcapitales consecutivas en 1.166 pacientes tratados con hemiartroplastia de Thompson tras una fractura subcapital de fémur entre 1989 y 2001. Se realizó seguimiento clínico de una muestra aleatoria de 220 fracturas; de éstas, 210 casos fueron seguidos al menos dos años o hasta el fallecimiento (95,5%). Se realizó un análisis multivariante del efecto de la edad, el sexo, las enfermedades asociadas, la demora de la intervención quirúrgica y las complicaciones postoperatorias en la supervivencia. Se analizó también la supervivencia de los implantes. La mediana de supervivencia fue de 4,5 años. El sexo masculino incrementaba la mortalidad (riesgo relativo [RR]= 2,47; intervalo de confianza para un 95% [IC 95%]: 1,65-3,70; p < 0,001) y también la edad avanzada (RR = 1,04; IC 95%: 1,01-1,07; p = 0,005). La demora de la intervención quirúrgica no afectaba la supervivencia a largo plazo, pero sí a los 6 meses teniendo los operados en el día del ingreso una mortalidad superior a la de los operados en los primeros 10 días tras el ingreso (33,3% frente a 10,4%; odds ratio [OR] = 4,38; IC 95%:1,12-16,5; p = 0,03). Sólo tres implantes fueron retirados, todos ellos por aflojamiento aséptico. Los factores que más aumentan la mortalidad en este grupo de pacientes son el sexo masculino, la edad y la presencia de enfermedades. Una demora de la intervención de 24 horas puede aumentar la supervivencia a corto plazo. Los implantes rara vez fracasan.
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More From: Revista española de cirugía ortopédica y traumatología (English edition)
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