Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
Acta Orthop. 2012 Oct;83(5):459-66. doi: 10.3109/17453674.2012.727076. Epub 2012 Sep 24.
Hemiarthroplasty as treatment for femoral neck fractures has increased markedly in Sweden during the last decade. In this prospective observational study, we wanted to identify risk factors for reoperation in modular hemiarthroplasties and to evaluate mortality in this patient group.
We assessed 23,509 procedures from the Swedish Hip Arthroplasty Register using the most common surgical approaches with modular uni- or bipolar hemiarthroplasties related to fractures in the period 2005-2010. Completeness of registration (individual procedures) was 89-96%. The median age was 85 years and the median follow-up time was 18 months.
3.8% underwent reoperation (any further hip surgery), most often because of implant dislocation or infection. The risk of reoperation (Cox regression) was higher for uncemented stems (hazard ratio (HR) = 1.5), mainly because of periprosthetic femoral fractures. Bipolar implants had a higher risk of reoperation irrespective of cause (HR = 1.3), because of dislocation (1.4), because of infection (1.3), and because of periprosthetic fracture (1.7). The risk of reoperation due to acetabular erosion was lower (0.30) than for unipolar implants, but reoperation for this complication was rare (1.7 per thousand). Procedures resulting from failed internal fixation had a more than doubled risk; the risk was also higher for males and for younger patients. The surgical approach had no influence on the risk of reoperation generally, but the anterolateral transgluteal approach was associated with a lower risk of reoperation due to dislocation (HR = 0.7). At 1 year, the mortality was 24%. Men had a higher risk of death than women (1.8).
We recommend cemented hemiarthroplasties and the anterolateral transgluteal approach. We also suggest that unipolar implants should be used, at least for the oldest and frailest patients.
在过去十年中，瑞典的股骨颈骨折半髋关节置换术显著增加。在这项前瞻性观察研究中，我们希望确定模块化半髋关节置换术后再次手术的风险因素，并评估该患者群体的死亡率。
我们使用最常见的手术方法评估了 2005-2010 年间瑞典髋关节置换登记处的 23509 例手术，这些手术方法与骨折相关，使用的是模块化单极或双极半髋关节置换。登记的完整性（个体手术）为 89-96%。中位年龄为 85 岁，中位随访时间为 18 个月。
3.8%的患者进行了再次手术（任何进一步的髋关节手术），最常见的原因是假体脱位或感染。（Cox 回归）再次手术的风险更高的是未固定的股骨柄（风险比（HR）=1.5），主要是因为假体周围股骨骨折。无论原因如何，双极假体的再次手术风险更高（HR=1.3），包括脱位（1.4）、感染（1.3）和假体周围骨折（1.7）。由于髋臼侵蚀导致再次手术的风险较低（0.30），但这种并发症导致的再次手术很少见（每千例 1.7 例）。内固定失败导致的手术风险增加了一倍以上，男性和年轻患者的风险也更高。手术入路通常不会影响再次手术的风险，但前外侧经臀肌入路与因脱位导致的再次手术风险较低有关（HR=0.7）。1 年内，死亡率为 24%。男性的死亡风险高于女性（1.8）。
我们建议使用骨水泥半髋关节置换和前外侧经臀肌入路。我们还建议至少对最年长和最虚弱的患者使用单极假体。
