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Low conversion rates toward total hip arthroplasty after hemiarthroplasty in patients under 75 years of age

  • P. P. SchmitzEmail author
  • J. L. C. van Susante
  • M. P. Somford
Original Article • HIP - ARTHROPLASTY
  • 57 Downloads

Abstract

Introduction

An intracapsular fracture of the femoral neck is frequent in the elderly. Patients can be treated with either total hip arthroplasty or hemiarthroplasty. There is a continuous discussion about the treatment in elderly patients who are still healthy, active and mentally untroubled. A potential consequence of hemiarthroplasty, especially in the relatively young elderly, could be conversion to total hip arthroplasty. The conversion rate must be acceptable, and clinical outcome must be sufficient to justify the treatment with hemiarthroplasty in this group of patients. This study evaluates the conversion rate of hemiarthroplasty to total hip arthroplasty and clinical outcome in patients under 75 years of age.

Methods

This study identified 248 patients, younger than 75 years at time of operation, with a fracture of the femoral neck treated with hemiarthroplasty. Patient-reported outcome measurements (VAS pain during rest and activity and WOMAC) were assessed by telephone interviews. Furthermore, radiographic evaluation for the presence of acetabular wear was performed.

Results

At a follow-up of 5.1 (0.9–9.6) years, the conversion rate was 7.3%. Mean VAS pain in rest was 0.89 (0–10), the mean VAS pain during activity was 2.2 (0–10), and the WOMAC showed a mean of 16.51 (0–64). At time of follow-up, 38.7% of patients had died. Radiographic evaluation of the unrevised group showed in one patient signs of acetabulum wear.

Conclusion

Hemiarthroplasty in the relatively young elderly after a fracture of the femoral neck demonstrates an acceptable conversion rate. Furthermore, unrevised patients show low complaints of pain. To prevent one conversion to total hip arthroplasty, 13.7 patients should be treated with total hip arthroplasty that will not undergo a conversion at a later stage. Therefore, hemiarthroplasty remains a viable treatment of femoral neck fractures in relatively young patients. There seems to be no space for standardized decision making concerning the choice of treatment. An individual approach is required.

Keywords

Femoral neck fractures Hemiarthroplasty Conversion Under 75 years 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical statement

The procedures followed were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki Declaration and its later amendments.

References

  1. 1.
    Kannan A, Kancherla R, McMahon R, Hawdon G, Soral A, Malhotra R (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop 36:1–8.  https://doi.org/10.1007/s00264-011-1354-z CrossRefPubMedGoogle Scholar
  2. 2.
    Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC (2011) Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br 93(8):1045–1048.  https://doi.org/10.1302/0301-620X.93B8.27132 CrossRefPubMedGoogle Scholar
  3. 3.
    Leonardsson O, Rolfson O, Hommel A, Garellick G, Åkesson K, Rogmark C (2013) Patient-reported outcome after displaced femoral neck fracture a national survey of 4467 patients. J Bone Joint Surg Am 95(18):1693–1699.  https://doi.org/10.2106/JBJS.L.00836 CrossRefPubMedGoogle Scholar
  4. 4.
    Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Br. 93(8):1045–1048.  https://doi.org/10.1302/0301-620x.93b8.27132 CrossRefGoogle Scholar
  5. 5.
    Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur–13 year results of a prospective randomised study. Injury 31(10):793–797CrossRefGoogle Scholar
  6. 6.
    Guyen O (2019) Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res 105(1S):S95–S101.  https://doi.org/10.1016/j.otsr.2018.04.034 CrossRefPubMedGoogle Scholar
  7. 7.
    Von Roth P, Abdel MP, Harmsen WS, Berry DJ (2015) Cemented bipolar hemiarthroplasty provides definitive treatment for femoral neck fractures at 20 years and beyond. Clin Orthop Relat Res 473(11):3595–3599.  https://doi.org/10.1007/s11999-015-4462-z CrossRefGoogle Scholar
  8. 8.
    Murena L, Fattori R, Scamacca V, Cau P, Ratti C, Canton G (2016) Treatment of intracapsular fractures of the proximal femur with bipolar hemiarthroplasty in patients under the age of 70: clinical and radiographic results at mean 20 years follow-up. Acta Biomed 87(Suppl 1):53–59PubMedGoogle Scholar
  9. 9.
    van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers EL (2010) A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br 92(10):1422–1428.  https://doi.org/10.1302/0301-620X.92B10.24899 CrossRefPubMedGoogle Scholar
  10. 10.
    Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 16:229.  https://doi.org/10.1186/s12891-015-0696-x CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, Tidermark J (2011) Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 93(5):445–450.  https://doi.org/10.2106/JBJS.J.00474 CrossRefPubMedGoogle Scholar
  12. 12.
    Phillips TW (1989) Thompson hemiarthroplasty and acetabular erosion. J Bone Joint Surg Am 71(6):913–917CrossRefGoogle Scholar
  13. 13.
    Van den Bekerom MPJ, Sierevelt IN, Bonke H, Raaymakers ELFB (2013) The natural history of the hemiarthroplasty for displaced intracapsular femoral neck fractures. Acta Orthop 84(6):555–560.  https://doi.org/10.3109/17453674.2013.867763 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Grosso MJ, Danoff JR, Murtaugh TS, Trofa DP, Sawires AN, Macaulay WB (2017) Hemiarthroplasty for displaced femoral neck fractures in the elderly has a low conversion rate. J Arthroplasty 32(1):150–154.  https://doi.org/10.1016/j.arth.2016.06.048 CrossRefPubMedGoogle Scholar
  15. 15.
    Dolan P, Sutton M (1997) Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values. Soc Sci Med 44(10):1519–1530CrossRefGoogle Scholar
  16. 16.
    Robinson A, Dolan P (1997) Williams A (1997) valuing health status using VAS and TTO. Soc Sci Med 45(8):1289–1297CrossRefGoogle Scholar
  17. 17.
    Bellamy NW, Buchannan WW, Goldsmith CH, Cambell J, Stitt LW (1988) Validation study of WOMAC. J Rheumatol 15(12):1833–1840PubMedGoogle Scholar
  18. 18.
    Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, Willems WJ, Heyligers IC, Voaklander DC, Kelly KD, Suarez-Almazor ME (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63(1):36–42CrossRefGoogle Scholar
  19. 19.
    Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ (2019) Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-matched, population-based study. J Bone Joint Surg Am. 101(7):572–579.  https://doi.org/10.2106/jbjs.18.00539 CrossRefPubMedGoogle Scholar
  20. 20.
    Moerman S, Mathijssen NMC, Tuinebreijer WE, Vochteloo AJH, Nelissen RGHH (2018) Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision. Acta Orthop 89(5):509–514.  https://doi.org/10.1080/17453674.2018.1499069 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • P. P. Schmitz
    • 1
    Email author
  • J. L. C. van Susante
    • 1
  • M. P. Somford
    • 1
  1. 1.Department of OrthopedicsRijnstate Hospital ArnhemArnhemThe Netherlands

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