Amir Khoshbin1, Graeme Hoit2, Patrick D G Henry3, J Michael Paterson4, Anjie Huang5, Amit Atrey1, Hans J Kreder6, Richard Jenkinson3, David Wasserstein3. 1. Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 2. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. 3. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. 4. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada. 5. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada. 6. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Geriatric patients are the most rapidly growing cohort of patients sustaining acetabular fractures (AFs). The purpose of this study was to examine the risk of a secondary total hip arthroplasty (THA) in older patients (>60 year old) with a prior AF open reduction internal fixation (ORIF) compared with younger patients (<60 year old) with an AF ORIF on a large population level. METHODS: Using administrative health care data from 1996 to 2010 inclusive of all 202 hospitals in Ontario, Canada, all adult patients with an AF ORIF and a minimum of two year follow-up were identified and included. The risk of THA was examined using a Cox proportional hazards model adjusting for patient risk factors. Secondary outcomes included surgical complications and all-cause mortality. RESULTS: A total of 1725 patients had an AF ORIF; 1452 (84.2%, mean age of 38.3 ± 12.1 years) aged <60 years ("younger") and 273 (15.8%, mean age of 69.9 ± 7.8 years) > 60 years ("older"). The mean (SD) follow-up time for all patients was 6.9 (4.2) years. In older patients, 19.4% (53 of 273) went on to receive a secondary THA with a median time to event of 3.9 years, compared with 12.9% (187 of 1452) in the younger patient cohort with a median time of 6.9 years (HR 1.7, 95% CI: 1.2-2.3). As expected, older patients had a higher 90-day mortality rate compared with younger patients (7.7% vs. 0.7%, respectively; HR 9.2, 95% CI: 4.3-19.9; P < .001). CONCLUSION: Older patients with an AF ORIF are at a significantly higher risk for a secondary THA than younger patients with an AF ORIF.
BACKGROUND: Geriatric patients are the most rapidly growing cohort of patients sustaining acetabular fractures (AFs). The purpose of this study was to examine the risk of a secondary total hip arthroplasty (THA) in older patients (>60 year old) with a prior AF open reduction internal fixation (ORIF) compared with younger patients (<60 year old) with an AF ORIF on a large population level. METHODS: Using administrative health care data from 1996 to 2010 inclusive of all 202 hospitals in Ontario, Canada, all adult patients with an AF ORIF and a minimum of two year follow-up were identified and included. The risk of THA was examined using a Cox proportional hazards model adjusting for patient risk factors. Secondary outcomes included surgical complications and all-cause mortality. RESULTS: A total of 1725 patients had an AF ORIF; 1452 (84.2%, mean age of 38.3 ± 12.1 years) aged <60 years ("younger") and 273 (15.8%, mean age of 69.9 ± 7.8 years) > 60 years ("older"). The mean (SD) follow-up time for all patients was 6.9 (4.2) years. In older patients, 19.4% (53 of 273) went on to receive a secondary THA with a median time to event of 3.9 years, compared with 12.9% (187 of 1452) in the younger patient cohort with a median time of 6.9 years (HR 1.7, 95% CI: 1.2-2.3). As expected, older patients had a higher 90-day mortality rate compared with younger patients (7.7% vs. 0.7%, respectively; HR 9.2, 95% CI: 4.3-19.9; P < .001). CONCLUSION: Older patients with an AF ORIF are at a significantly higher risk for a secondary THA than younger patients with an AF ORIF.
Authors: Michalis Panteli; Panayiotis Souroullas; Sushmith R Gowda; James S H Vun; Anthony J Howard; Nikolaos K Kanakaris; Peter V Giannoudis Journal: Eur J Trauma Emerg Surg Date: 2022-10-19 Impact factor: 2.374