Abstract
The aim of this study was to determine the association between patient-reported outcome measures (PROMs) six months following femoral neck fracture after a low fall and future arthroplasty, and the factors associated with this. Six-month post-fracture PROMs were collected from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) for patients aged >55 years who were admitted for a femoral neck fracture after a low fall between March 2007 and June 2015. These cases were linked with those registered by Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) up to October 2016. Multivariable analysis was performed using a Cox proportional hazards model to determine factors associated with future arthroplasty, including six-month PROMs. Of the 7077 hip fracture patients registered by VOTOR during the study period, 2325 met the inclusion criteria. Internal fixation being used for the initial hip fracture surgery, being younger and having no pre-injury disability were all independently associated with future revision or conversion to arthroplasty. Out of all PROMs, reporting pain and discomfort six months post-fracture was associated with a 9.5-fold increase in the risk of future arthroplasty (95% CI: 3.81, 23.67). The value of clinical registries can be enhanced via data linkage, in this case by using PROMs to predict arthroplasty following femoral neck fracture.
Highlights
Hip fractures are significant injuries that lead to reduced quality of life and increased mortality, especially in older patients [1,2]
Previous research has established that re-operation rates are lower for arthroplasty compared to internal fixation [5,6]
For younger hip fracture patients, internal fixation is often preferred over arthroplasty as it is associated with less operative trauma, reduced blood loss, and a lower risk of infection
Summary
Hip fractures are significant injuries that lead to reduced quality of life and increased mortality, especially in older patients [1,2]. Improved life expectancies are expected to increase the likelihood of patients requiring further hip surgery when previous surgical fixation has failed, or when the initial arthroplasty requires revision [4]. For younger hip fracture patients, internal fixation is often preferred over arthroplasty as it is associated with less operative trauma, reduced blood loss, and a lower risk of infection. In order to assess patient risk and guide surgical decision-making on the need for further surgery, it is important to understand factors associated with re-operation beyond just the technique and type of initial hip fracture surgery
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