Sheila Sprague1,2, Emil H Schemitsch3, Marc Swiontkowski4, Gregory J Della Rocca5, Kyle J Jeray6, Susan Liew7, Gerard P Slobogean8, Sofia Bzovsky2, Diane Heels-Ansdell1, Qi Zhou1, Mohit Bhandari1,2. 1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. 3. Department of Surgery, University of Western Ontario, London, ON, Canada. 4. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN. 5. Department of Orthopaedic Surgery, University of Missouri, School of Medicine, Columbia, MO. 6. Department of Orthopaedic Surgery, Greenville Health System, Greenville, SC. 7. Department of Orthopaedic Surgery, The Alfred, Melbourne, Victoria, Australia. 8. Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. METHODS: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. RESULTS: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal. CONCLUSIONS: Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020). LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND:Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. METHODS: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. RESULTS: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal. CONCLUSIONS: Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020). LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Authors: John A Scolaro; Mara L Schenker; Sarah Yannascoli; Keith Baldwin; Samir Mehta; Jaimo Ahn Journal: J Bone Joint Surg Am Date: 2014-04-16 Impact factor: 5.284
Authors: Ryan D DeAngelis; Matthew K Stein; Gregory T Minutillo; Nikhilesh G Mehta; Emil H Schemitsch; Sofia Bzovsky; Sheila Sprague; Mohit Bhandari; Marc Swiontkowski; Derek J Donegan; Samir Mehta Journal: J Orthop Trauma Date: 2022-04-01 Impact factor: 2.512
Authors: Patrick D Albright; Syed Haider Ali; Hunter Jackson; Billy T Haonga; Edmund Ndalama Eliezer; Saam Morshed; David W Shearer Journal: Clin Orthop Relat Res Date: 2020-08 Impact factor: 4.755