Monoblock hemiarthroplasties for femoral neck fractures - A part of orthopaedic history? Analysis of national registration of hemiarthroplasties 2005-2009

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• 作者：Cecilia Rogmark^a ; ^b ; ^{cecilia.rogmark@skane.se} ; Olof Leonardsson^a ; Gö ; ran Garellick^b ; Johan Kä ; rrholm^b ; ^c
• 关键词：Hip fractures ; Arthroplasty ; Complications ; Re-operations ; National register
• 刊名：Injury
• 出版年：2012
• 出版时间：June, 2012
• 年：2012
• 卷：43
• 期：6
• 页码：946-949
• 全文大小：153 K

文摘

This study from the Swedish Hip Arthroplasty Register (SHAR) compares cemented (Thompson^?, Exeter Trauma Stem (ETS)^?) and uncemented (Austin-Moore^?) monoblock hemiarthroplasties (n = 1116 and 616, respectively) with modular ones (n = 18,659).

Austin-Moore^? prostheses lead to more re-operations (6.7 % ) compared to modular implants (3.5 % ) and Thompson^?/ETS^? (2.4 % ).

A Cox regression analysis, adjusting for other risk factors, shows twice the risk of re-operation for Austin-Moore^? implants (CI 1.5-2.8), in particular, due to periprosthetic fracture (5.4; CI 3.2-9.1) and dislocation (1.9; CI 1.3-3.0). The Thompson^?/ETS^? implants do not influence the overall risk of re-operation (0.7; CI 0.5-1.2) compared to modular implants and decrease the risk of re-operation due to infection (0.2;CI 0.04-0.7). An increased risk of re-operation is also seen in men, age groups 75-85 years and <75 years and after secondary fracture surgery.

Both Swedish and Australian orthopaedic surgeons have decreased their use of Austin-Moore^? implants after reports from their national arthroplasty registers identifying inferior outcome for this implant. Due to the increased risk of re-operations, it should not be used in modern orthopaedic care. Cemented Thompson^? or ETS^? implants could still be suitable for the oldest, low-activity patients. To finally decide if there is a place for them, patient-reported outcome must be analysed as well.