Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #76, 11:09 am OTA-2011
Influence of Displacement and Treatment Method on Survivorship of the Index Procedure for Femoral Neck Fracture
Donavan K. Murphy, MD, MSc, MBA; Timmothy Randell, MD; Kindyle L. Brennan, PhD, PT; Juhee Song, PhD; John M. Hamilton, BA; Michael Brennan, MD; Robert A. Probe, MD;
Scott & White Memorial Hospital, Temple, Texas, USA
Purpose: This study was designed to assess the effect of fracture displacement and treatment modality on the rate of revision surgery following femoral neck fracture (FNF).
Methods: A single-institution retrospective review of medical records and radiographs was performed on 580 patients (612 hips) treated surgically for FNF between 1998 and 2009. Exclusion criteria included age less than 60 years, high-energy etiology, and neoplasia. A multivariable Cox proportional hazards regression model was created to investigate factors associated with greater risk of revision.
Results: The average patient age (±standard deviation) was 82 (±8) years and 484 cases (79%) were females. 291 cases (48%) were treated with CRPP (closed reduction percutaneous pinning), and 321 (52%) were treated with HA (hemiarthroplasty). 181 fractures (30%) were classified as nondisplaced (170 treated with CRPP; 11 treated with HA), while 431 cases (70%) were classified as displaced (121 treated with CRPP; 310 treated with HA). 95 cases (15.6% [2 bilateral]) received revision surgery. CRPP resulted in a 17% (29 of 170) rate of revision in the nondisplaced group and a 40% (50 of 121) failure rate in displaced FNFs. The 3 most common reasons requiring revision following CRPP were loss of fixation (n = 29), nonunion (n = 28), and avascular necrosis (n = 10). HA resulted in no revisions (0/11) in the nondisplaced group and a revision rate of 5% (16/310) in the displaced FNFs. In this revision group, the etiology was infection (n = 9), femoral loosening (n = 2), acetabular wear (n = 2), hematoma evacuation (n = 2), and periprosthetic fracture (n = 1). Revision-free survival estimates at 1 year for the nondisplaced group were 100% for HA, and 83% for CRPP. The displaced group survival estimates were 95% for HA, and 64% for CRPP. Univariate analysis showed that surgery type was the only significant variable associated with increased risk of revision (P <0.001). Multivariate analysis showed that fracture displacement (hazard ratio [HR], 2.79; 95% confidence interval [CI], 1.77-4.40; P <0.001) and CRPP surgery type (HR, 9.15; 95% CI, 5.22-16.05; P <0.001) were independent risk factors associated with increased risk of revision.
Conclusion: This study demonstrates that fracture displacement and CRPP are combined risk factors associated with increased rates of revision following surgical treatment of FNFs. This affirms previously reports showing high failure rates of CRPP in displaced fractures. However, this study reports a higher than expected failure rate of 17% for CRPP in nondisplaced FNFs.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.