Displaced femoral neck fractures in the elderly : treatment with arthroplasties
Author: Inngul, Christian
Date: 2015-06-12
Location: Sahl Ihre, Södersjukhuset, Sjukhusbacken 10, Stockholm
Time: 09.00
Department: Inst för klinisk forskning och utbildning, Södersjukhuset / Dept of Clinical Science and Education, Södersjukhuset
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Thesis (3.743Mb)
Abstract
Treatment of displaced femoral neck fractures in the elderly with arthroplasties has become
standard practice during the last decade and results in good and predictable outcomes regarding
hip function and health-related quality of life (HRQoL). There is, however, a lack of evidence
concerning certain types of arthroplasties and different subgroups of patients. Patients with
severe cognitive dysfunction have a very limited life expectancy after a hip fracture and low
functional demands, as well a low HRQoL before the injury. Many surgeons have concerns
regarding arthroplasties in these patients. The bipolar hemiarthroplasty (HA) is designed to
reduce stress and erosion on the patient`s natural acetabulum and should, in theory, render a
better functional outcome and HRQoL than the unipolar HA. Patients with arthroplasties after
displaced femoral neck fractures are at higher risk of sustaining a late periprosthetic fracture
(PPF) compared to patients treated due to degenerative joint disease. In addition, some
prosthetic designs have been pointed out as being a risk factor for PFF. Uncemented
arthroplasties are widely used for various indications and show excellent clinical results. In
addition, there are concerns about cementing in older frail patients with multiple comorbidities.
All patients in Studies I to IV have been treated with arthroplasties because of a displaced
femoral neck fracture.
Study I is a randomised controlled trial (RCT) comparing treatment with internal fixation (IF) and treatment with HA in patients with severe cognitive dysfunction. Compared to treatment with IF, HAs appear to result in a better HRQoL and fewer reoperations.
Study II is an RCT with a 48-month follow-up comparing bipolar and unipolar HAs. Treatment with a bipolar HA resulted in a better HRQoL after four years.
In Study III a cohort of 2757 patients with primary or secondary arthroplasties after femoral neck fractures were investigated. A single cemented femoral implant was used. The incidence of PPFs was high (2.3%) in the cohort, but the surgical outcome after reoperation for a PFF was better compared to previous reports.
Study IV is an RCT with a 12-month follow-up comparing uncemented arthroplasties with cemented arthroplasties. The uncemented arthroplasties showed inferior results regarding functional outcome and HRQoL.
The main conclusions of this thesis are: Treatment of displaced femoral neck fractures with arthroplasties is safe, even for patients with severe cognitive dysfunction; the use of uncemented arthroplasties should be avoided and there are still controversies regarding the use of bipolar Has.
Study I is a randomised controlled trial (RCT) comparing treatment with internal fixation (IF) and treatment with HA in patients with severe cognitive dysfunction. Compared to treatment with IF, HAs appear to result in a better HRQoL and fewer reoperations.
Study II is an RCT with a 48-month follow-up comparing bipolar and unipolar HAs. Treatment with a bipolar HA resulted in a better HRQoL after four years.
In Study III a cohort of 2757 patients with primary or secondary arthroplasties after femoral neck fractures were investigated. A single cemented femoral implant was used. The incidence of PPFs was high (2.3%) in the cohort, but the surgical outcome after reoperation for a PFF was better compared to previous reports.
Study IV is an RCT with a 12-month follow-up comparing uncemented arthroplasties with cemented arthroplasties. The uncemented arthroplasties showed inferior results regarding functional outcome and HRQoL.
The main conclusions of this thesis are: Treatment of displaced femoral neck fractures with arthroplasties is safe, even for patients with severe cognitive dysfunction; the use of uncemented arthroplasties should be avoided and there are still controversies regarding the use of bipolar Has.
List of papers:
I. Internal fixation versus cemented hemiarthroplasty for displaced femoral neck fractures in patients with severe cognitive dysfunction: a randomized controlled trial. Hedbeck CJ, Inngul C, Blomfeldt R, Ponzer S, Törnkvist H, Enocson A. J Orthop Trauma. 2013 Dec;27(12):690-5.
Fulltext (DOI)
Pubmed
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II. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Int Orthop. 2013 Dec;37(12):2457-64.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Postoperative periprosthetic fractures in patients with an Exeter stem due to a femoral neck fracture: cumulative incidence and surgical outcome. Inngul C, Enocson A. Int Orthop. 2014 Oct 24. [Epub ahead of print]
Fulltext (DOI)
Pubmed
IV. Cemented versus uncemented arthroplasty in patients with displaced femoral neck fractures: a randomised controlled trial. Inngul C, Blomfeldt R, Ponzer S, Enocson A. [Submitted]
I. Internal fixation versus cemented hemiarthroplasty for displaced femoral neck fractures in patients with severe cognitive dysfunction: a randomized controlled trial. Hedbeck CJ, Inngul C, Blomfeldt R, Ponzer S, Törnkvist H, Enocson A. J Orthop Trauma. 2013 Dec;27(12):690-5.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Int Orthop. 2013 Dec;37(12):2457-64.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Postoperative periprosthetic fractures in patients with an Exeter stem due to a femoral neck fracture: cumulative incidence and surgical outcome. Inngul C, Enocson A. Int Orthop. 2014 Oct 24. [Epub ahead of print]
Fulltext (DOI)
Pubmed
IV. Cemented versus uncemented arthroplasty in patients with displaced femoral neck fractures: a randomised controlled trial. Inngul C, Blomfeldt R, Ponzer S, Enocson A. [Submitted]
Institution: Karolinska Institutet
Supervisor: Enocson, Anders
Issue date: 2015-05-22
Rights:
Publication year: 2015
ISBN: 978-91-7549-982-6
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