Session I - Geriatrics
Primary Total Hip Replacement or Secondary Total Hip Replacement after Failed Internal Fixation of Displaced Femoral Neck Fractures in Elderly Patients: Are There Differences in Outcome?
Background: Recent randomized controlled trials have shown that for the active and lucid elderly patient with a displaced femoral neck fracture, a primary total hip replacement (THR) is superior to internal fixation (IF) in the need for secondary surgery, hip function, and the health-related quality of life (HRQoL). Despite the high failure rate for IF, the method is still recommended for this patient cohort by some authors. One argument is that if IF fails, performing a salvage THR is always an option. The primary aim of the study was to determine if there are any differences in outcome comparing a primary THR with a secondary THR after failed IF. The secondary aim was to describe the HRQoL in patients with failed IF who later underwent a secondary THR during the treatment period.
Methods: 84 patients (mean age, 80 years) treated for an acute displaced femoral neck fracture were included in a partly randomized controlled trial and partly case-control study. 43 patients were treated with a primary THR and 41 with a secondary THR after failed IF. The follow-up was 2 years after the THR procedure. The main outcome measurements were perioperative data, general complications, hip complications, activities of daily living (ADL) status, hip function (Charnley score), and the health-related quality of life (HRQoL, EQ-5D).
Results: The perioperative blood loss and need for transfusions were significantly higher in the secondary THR group (P<0.05). Hip function was significantly better in the primary THR group 2 years after surgery (P<0.05). The patients with failed IF later undergoing a secondary THR experienced a significant decrease in HRQoL (EQ-5D index score) during the first year of treatment compared with patients in the primary THR group (P<0.05). There were no differences in general complications, hip complications, or ADL status.
Conclusion/Significance: The results of this study indicate that a secondary THR after failed IF results in inferior hip function compared with a primary THR for a displaced femoral neck fracture in the active and lucid elderly patient. Moreover, the patients with failed IF had at least one reoperation and endured a significant decrease in their HRQoL before the salvage THR. Finally, the secondary THR seems to be a more complicated surgical procedure with increased perioperative bleeding and an increased need for postoperative blood transfusions.