title: Patient and implant survival following 4323 total hip replacements for acute femoral neck fracture: a retrospective cohort study using National Joint Registry data.
abstract: United Kingdom National Institute for Health   and Clinical Excellence guidelines recommend the use of total hip replacement   (THR) for displaced intracapsular fractures of the femoral neck   in cognitively intact patients, who were independently mobile prior   to the injury. This study aimed to analyse the risk factors associated   with revision of the implant and mortality following THR, and to   quantify risk. National Joint Registry data recording a THR performed   for acute fracture of the femoral neck between 2003 and 2010 were   analysed. Cox proportional hazards models were used to investigate   the extent to which risk of revision was related to specific covariates.   Multivariable logistic regression was used to analyse factors affecting   peri-operative mortality (< 90 days). A total of 4323 procedures   were studied. There were 80 patients who had undergone revision   surgery at the time of censoring (five-year revision rate 3.25%, 95%   confidence interval 2.44 to 4.07) and 137 patients (3.2%) patients   died within 90 days. After adjusting for patient and surgeon characteristics,   an increased risk of revision was associated with the use of cementless   prostheses compared with cemented (hazard ratio (HR) 1.33, p = 0.021).   Revision was independent of bearing surface and head size. The risk   of mortality within 90 days was significantly increased with higher   American Society of Anesthesiologists (ASA) grade (grade 3: odds   ratio (OR) 4.04, p < 0.001; grade 4/5: OR 20.26, p < 0.001;   both compared with grades 1/2) and older age (≥ 75 years: OR 1.65,   p = 0.025), but reduced over the study period (9% relative risk reduction   per year). THR is a good option in patients aged < 75 years and with   ASA 1/2. Cementation of the femoral component does not adversely   affect peri-operative mortality but improves survival of the implant   in the mid-term when compared with cementless femoral components.   There are no benefits of using head sizes > 28 mm or bearings other   than metal-on-polyethylene. More research is required to determine   the benefits of THR over hemiarthroplasty in older patients and   those with ASA grades > 2.
authors.affiliation: School of Medicine and Health, Durham University, Stockton-on-Tees, UK. simonjameson@doctors.org.uk
authors.forename: S S
authors.initials: SS
authors.lastname: Jameson
authors.forename: J
authors.initials: J
authors.lastname: Kyle
authors.forename: P N
authors.initials: PN
authors.lastname: Baker
authors.forename: J
authors.initials: J
authors.lastname: Mason
authors.forename: D J
authors.initials: DJ
authors.lastname: Deehan
authors.forename: I A
authors.initials: IA
authors.lastname: McMurtry
authors.forename: M R
authors.initials: MR
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D006113:United Kingdom; D055815:Young Adult