Department of Orthopaedics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Clinical Sciences and Department of Orthopaedics, Lund University and Lund University Hospital, Lund, Sweden.
Hip Int. 2021 Sep;31(5):691-695. doi: 10.1177/1120700020907124. Epub 2020 Feb 9.
Elderly patients with displaced femoral neck fractures (FNF) are usually operated with arthroplasty but with various combinations of implants and approaches. Thus, the optimal treatment is still controversial. We aimed to compare the results between the cemented bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) patients operated for FNF regarding revision rate at 1 year postoperatively.
The data were derived from the Lithuanian Arthroplasty Register. We included patients operated with cemented bipolar HA and compared them to the most frequently used cemented THA with 28-mm head during 2011-2016. For survival analysis, we used both revision for all reasons and for dislocations as an endpoint. Cox proportional hazards models were used to analyse the influence of covariates (age groups, gender, surgical approaches and arthroplasty groups).
There were 1177 bipolar HA and 514 THA included in our study. 26 (2.2%) revisions had occurred among the bipolar HAs as compared to 25 (4.9%) among the THAs 1 year after surgery. The main reason for revision was dislocation. The unadjusted cumulative revision rate for any reason at 1 year after surgery was 2.4% for the bipolar HA group and 5.1% for the THA group ( 0.0054). Cox regression analysis showed that the use of bipolar HA, anterolateral approach and younger age groups had lower risk of revision for all reasons.
Bipolar HA and anterolateral approach had a significantly lower overall 1-year risk of revision in femoral neck fracture patients as compared to THA with 28-mm femoral heads.
患有移位股骨颈骨折（FNF）的老年患者通常采用关节置换术治疗，但植入物和手术入路的组合各不相同。因此，最佳治疗方法仍存在争议。我们旨在比较使用骨水泥固定双极半髋关节置换术（HA）和全髋关节置换术（THA）治疗 FNF 的患者在术后 1 年时的翻修率。
数据来源于立陶宛关节置换登记处。我们纳入了接受骨水泥固定双极 HA 治疗的患者，并将其与在 2011 年至 2016 年期间最常使用的 28 毫米头骨水泥固定 THA 进行比较。对于生存分析，我们使用所有原因的翻修和脱位作为终点。Cox 比例风险模型用于分析协变量（年龄组、性别、手术入路和关节置换组）的影响。
本研究共纳入 1177 例双极 HA 和 514 例 THA。与手术后 1 年的 25 例（4.9%）相比，26 例（2.2%）双极 HA 发生了翻修。翻修的主要原因是脱位。手术后 1 年，任何原因的未调整累积翻修率，双极 HA 组为 2.4%，THA 组为 5.1%（ 0.0054）。Cox 回归分析表明，使用双极 HA、前外侧入路和年龄较小的患者群体，任何原因的翻修风险均较低。
与使用 28 毫米股骨头的 THA 相比，双极 HA 和前外侧入路在股骨颈骨折患者中，总体 1 年翻修风险显著降低。
