Influence of Internal Fixation and Cemented Hemiarthroplasty on 1-Year Mortality in Geriatric Hip Fracture Patients

Johannes K.M. Fakler,Christoph Josten,Nikolaus von Dercks,Antonia Grafe,Ulrich J.A. Spiegl,Jan Theopold

doi:10.17554/j.issn.2311-5106.2017.04.199

Johannes K.M. Fakler, Christoph Josten + Show 4 more

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https://doi.org/10.17554/j.issn.2311-5106.2017.04.199

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Abstract

AIM: Results after cemented Hemiarthoplasty (HA) in elderly patients with a femoral neck fracture improved over the last 20 years. We conducted this study in order to evaluate the influence of modern cemented HA compared to IF with a sliding hip screw (SHS) with regard to one year mortality. PATIENTS AND METHODS: 183 patients with a low-energy medial femoral neck fracture (AO/OTA 31-B) either treated with a SHS (n = 67) or cemented HA (n = 116) were included. Follow-up was performed at 6 and 12 months. A multivariate Cox regression analysis including nine confounding variables (age, ASA score, body mass index (BMI), cognitive function, time from admission to surgery, creatinine, c-reactive protein (CRP), 25-hydroxyvitamin D (25(OH)D) was performed. RESULTS: Patients in the HA group were significantly older (p < 0.001) and had more severe comorbidities according to the ASA-Score (p = 0.017). The time interval from admission to surgery (skin incision) was beyond 48h in 6.0% of SHS patients and 17.2% in HA patients (p < 0.001). Despite of detrimental prerequisites for cemented HA, mortality rates at 1 year for HA (23.3%) showed no significant difference (p = 0.58) to IF (19.4%). After correcting for confounding variables mortality risk at one year was significantly higher in patients treated with a SHS (HR = 2.5, 95%CI 1.1-5.7; p = 0.027). CONCLUSION: We conclude that elderly patients with a femoral neck fracture might benefit from cemented HA compared to IF with a SHS in terms of 1-year mortality. New randomised controlled trials considering modern cementing techniques are needed to validate these results.

Highlights

Femoral neck fractures in elderly patients are associated with high mortality during the first year
Without considering confounding variables 1-year mortality in our study cohort of elderly patients with a medial femoral neck fracture seems not be influenced by the surgical procedure or choice of implant
Patients in the HA group were significantly older, had more severe comorbidities reflected by American Society of Anaesthesiologists (ASA)-Scores and presented with cognitive impairment more frequently

Summary

Introduction

Femoral neck fractures in elderly patients are associated with high mortality during the first year. Fakler JKM et al Internal fixation vs hemiarthroplasty in geriatric femoral neck fracture patients impairment or level of activity were shown to be associated with an increased mortality risk in these patients[3,4]. Numerous randomized controlled trails (RCTs) and meta-analyses demonstrated no difference in one year mortality between internal fixation (IF) and hemiarthroplasty (HA)[8,9,10,11,12]. Many of these studies restrict their inclusion criteria to only a subset of patients which might result in considerable bias. Potentially important confounders as timing of surgery are not respected in recent RCTs[8,9,10,11], it was shown that a delay in surgery is associated with increased morbidity[14] and mortality[15]

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