Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients.
BACKGROUND
Hemiarthroplasties are performed in great numbers worldwide but are seldom registered on a national basis. Our aim was to identify risk factors for reoperation after fracture-related hemiarthroplasty in Norway and Sweden.


METHODS
A common dataset was created based on the Norwegian Hip Fracture Register and the Swedish Hip Arthroplasty Register. 33,205 hip fractures in individuals > 60 years of age treated with modular hemiarthroplasties were reported for the period 2005-2010. Cox regression analyses based on reoperations were performed (covariates: age group, sex, type of stem and implant head, surgical approach, and hospital volume).


RESULTS
1,164 patients (3.5%) were reoperated during a mean follow-up of 2.7 (SD 1.7) years. In patients over 85 years, an increased risk of reoperation was found for uncemented stems (HR = 2.2, 95% CI: 1.7-2.8), bipolar heads (HR = 1.4, CI: 1.2-1.8), posterior approach (HR = 1.4, CI: 1.2-1.8) and male sex (HR = 1.3, CI: 1.0-1.6). For patients aged 75-85 years, uncemented stems (HR = 1.6, 95% CI: 1.2-2.0) and men (HR = 1.3, CI: 1.1-1.6) carried an increased risk. Increased risk of reoperation due to infection was found for patients aged < 75 years (HR = 1.5, CI: 1.1-2.0) and for uncemented stems. For open surgery due to dislocation, the strongest risk factor was a posterior approach (HR = 2.2, CI: 1.8-2.6). Uncemented stems in particular (HR = 3.6, CI: 2.4-5.3) and male sex increased the risk of periprosthetic fracture surgery.


CONCLUSIONS
Cemented stems and a direct lateral transgluteal approach reduced the risk of reoperation after hip fractures treated with hemiarthroplasty in patients over 75 years. Men and younger patients had a higher risk of reoperation. For the age group 60-74 years, there were no such differences in risk in this material.
Department of Orthopaedics , Lund University, Skåne University Hospital , Malmö
Cecilia
C
Rogmark
Anne M
AM
Fenstad
Olof
O
Leonardsson
Lars B
LB
Engesæter
Johan
J
Kärrholm
Ove
O
Furnes
Göran
G
Garellick
Jan-Erik
JE
Gjertsen
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D002484:Cementation; D003704:Dementia / Q000150:complications / Q000453:epidemiology; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000379:methods; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D057068:Periprosthetic Fractures / Q000453:epidemiology / Q000601:surgery; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome