Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Bone Joint J. 2019 Jun;101-B(6_Supple_B):84-90. doi: 10.1302/0301-620X.101B6.BJJ-2018-1427.R1.
Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNFs), especially in physiologically younger patients. While THA for osteoarthritis (OA) has demonstrated low complication rates and increased quality of life, results of THA for acute FNF are not as clear. Currently, a THA performed for FNF is included in an institutional arthroplasty bundle without adequate risk adjustment, potentially placing centres participating in fracture care at financial disadvantage. The purpose of this study is to report on perioperative complication rates after THA for FNF compared with elective THA performed for OA of the hip.
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2008 and 2016 was queried. Patients were identified using the THA Current Procedural Terminology (CPT) code and divided into groups by diagnosis: OA in one and FNF in another. Univariate statistics were performed. Continuous variables were compared between groups using Student's -test, and the chi-squared test was used to compare categorical variables. Multivariate and propensity-matched logistic regression analyses were performed to control for risk factors of interest.
Analyses included 139 635 patients undergoing THA. OA was the indication in 135 013 cases and FNF in 4622 cases. After propensity matching, mortality within 30 days (1.8% 0.3%; p < 0.001) and major morbidity (24.2% 19%; p < 0.001) were significantly higher among FNF patients. Re-operation (3.7% 2.7%; p = 0.014) and re-admission (7.3% 5.5%; p = 0.002) were significantly higher among FNF patients. Hip fracture patients had significantly longer operative time and length of stay (LOS), and were significantly less likely to be discharged to their home. Multivariate analyses gave similar results.
This large database study showed a higher risk of postoperative complications including mortality, major morbidity, re-operation, re-admission, prolonged operative time, increased LOS, and decreased likelihood of discharge home in patients undergoing THA for FNF compared with OA. While THA is a good option for FNF patients, there are increased costs and financial risks to centres with a joint arthroplasty bundle programme participating in fracture care. Cite this article: 2019;101-B(6 Supple B):84-90.
全髋关节置换术（THA）作为治疗股骨颈骨折（FNF）的一种方法越来越受欢迎，尤其是在生理上更年轻的患者中。虽然 THA 治疗骨关节炎（OA）的并发症发生率低，生活质量提高，但急性 FNF 的 THA 结果并不明确。目前，FNF 行 THA 包含在机构关节置换套餐中，没有进行充分的风险调整，可能使参与骨折治疗的中心处于经济劣势。本研究的目的是报告 FNF 行 THA 的围手术期并发症发生率，并与髋关节 OA 的择期 THA 进行比较。
2008 年至 2016 年，查询美国外科医师学会国家手术质量改进计划（ACS NSQIP）数据库。使用 THA 当前程序术语（CPT）代码识别患者，并根据诊断将其分为两组：一组为 OA，另一组为 FNF。进行单变量统计分析。使用学生 t 检验比较组间连续变量，使用卡方检验比较分类变量。进行多变量和倾向匹配的逻辑回归分析，以控制感兴趣的风险因素。
分析纳入 139635 例行 THA 的患者。OA 为 135013 例，FNF 为 4622 例。在倾向匹配后，30 天内死亡率（1.8%比 0.3%；p<0.001）和主要发病率（24.2%比 19%；p<0.001）在 FNF 患者中显著更高。再次手术（3.7%比 2.7%；p=0.014）和再次入院（7.3%比 5.5%；p=0.002）在 FNF 患者中显著更高。FNF 患者的手术时间和住院时间明显更长（p<0.001），出院回家的可能性明显降低。多变量分析得出了类似的结果。
这项大型数据库研究表明，与 OA 相比，FNF 患者行 THA 后发生术后并发症的风险更高，包括死亡率、主要发病率、再次手术、再次入院、手术时间延长、住院时间延长以及出院回家的可能性降低。虽然 THA 是 FNF 患者的一种较好选择，但参与骨折治疗的关节置换套餐计划的中心会面临更高的成本和财务风险。
