Disorder-related risk factors for revision total hip arthroplasty after hip hemiarthroplasty in displaced femoral neck fracture patients: a nationwide population-based cohort study.
BACKGROUND
The choice of primary hip hemiarthroplasty or total hip arthroplasty for displaced femoral neck fracture is still controversial. Revision hip arthroplasty not only increases risk and cost but also could result in worse outcome. Determining the risk factors for revision can help inform medical decision-making and aid in risk stratification of publicly reported outcomes. Therefore, we conducted a nationwide population-based study to identify the disease-related risk factors and construct a risk score nomogram to predict revision surgery.


METHODS
Records of all 68,030 femoral neck fracture patients receiving partial hemiarthroplasty (HA) in 2000-2010, with no total hip arthroplasty (THA) or revision HA history, were collected from the National Health Insurance Research Database. Cox proportional hazard regression was used to estimate the risk of revision hip replacement (RHA). The score of each risk factor was the quotient of the regression coefficient of the variable by the regression coefficient for a 10-year increase in age. The predictive accuracy was tested using the area under the receiver operating characteristic curve (AUROC).


RESULTS
The revision risk for hemiarthroplasty increased in male, those with schizophrenia and end-stage renal disease patients had 1.58-, 1.88-, and 1.74-fold revision HA risk (95 % confidence interval (CI) = 1.40-1.78, 1.26-2.79, and 1.29-2.34, respectively). In a predictive model, the cumulative risk score ranged from 0 to 13 with a 5.08 to 91.82 % 10-year predicted RHA risk. The percentage of AUROC for 10-year RHA risk in nomogram was 61.9 (95 % CI = 60.0-63.4).


CONCLUSIONS
Males, schizophrenia and end-stage renal disease patients have higher risk of revision surgery after hemiarthroplasty for femoral neck fracture.
Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.|Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.
Chun-Hao
CH
Tsai
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Chih-Hsin
CH
Muo
Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan.
Chih-Hung
CH
Hung
Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.
Tsung-Li
TL
Lin
Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.
Ta-Ii
TI
Wang
Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan.|China Medical University Beigang Hospital, Yunlin, Taiwan.|School of Chinese Medicine, China Medical University, Taichung, Taiwan.
Yi-Chin
YC
Fong
Department of Orthopedic Surgery, China Medical University Hospital, #91 Hsueh-Shih Road, Taichung, 404, Taiwan. ritsai8615@gmail.com.|School of Medicine, China Medical University, Taichung, Taiwan. ritsai8615@gmail.com.|Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan. ritsai8615@gmail.com.
Horng-Chaung
HC
Hsu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000601:surgery*; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012086:Reoperation / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000601:surgery; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult