Thurs., 10/4/12 Hip Fractures, PAPER #29, 3:32 pm OTA-2012
Internal Fixation Versus Cemented Unipolar Hemiarthroplasty for Displaced Femoral eck Fractures in Elderly Patients With Severe Cognitive Dysfunction: A Randomized, Controlled Trial
Carl-Johan Hedbeck, MD; Christian Inngul; Richard Blomfeldt, MD; Hans Törnkvist, MD, PhD; Sari Ponzer, MD, PhD; Anders G. Enocson, MD, PhD;
Karolinska Institutet, Department of Clinical Science and Education, Orthopaedic Unit,
Stockholm Söder Hospital, Stockholm, Sweden
Background/Purpose: Hemiarthroplasty (HA) is a well-established method for treatment of displaced femoral neck fractures in elderly patients. However, most surgeons have concerns about arthroplasty in patients with severe cognitive dysfunction due to the risk for complications such as dislocations and periprosthetic fractures. The aim of this study was to compare the outcome of internal fixation (IF) versus a cemented HA in femoral neck fracture patients with severe cognitive dysfunction.
Methods: 59 patients with a displaced femoral neck fracture were randomized to IF using 2 cannulated screws (n = 30) or a cemented Exeter HA (n = 29). Allpatients had severe cognitive dysfunction, but were able to walk independently before the fracture. They were reviewed at 4, 12, and 24 months after the fracture. Outcome assessments included complications, reoperations, hip function (Charnley score), and health-related quality of life (EQ-5Dindex score).
Results: A total of eight patients were reoperated (14%). Seven were in the IF group: nonunion (n = 4), trochanteric refracture (n = 2), and lateral pain from protruding screws (n = 1). One patient in the HA group was reoperated due to prosthetic dislocation. The EQ-5Dindex score at the follow-ups were generally lower in the IF group compared to the HA group. At 12 months the difference was significant (P = 0.03); although consistent, due to the high mortality (63%), the difference was not significant at the 24-month follow-up.
Conclusion: HA seems to provide a safe option with better health-related quality of life compared with IF for these patients.
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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.