Blanco J F, da Casa C, Fidalgo H, García-Iglesias M A, González-Garcia L, Burón-Alvarez I, Sañudo S, García-Alonso M
Orthopaedic Surgery and Traumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Rev Esp Cir Ortop Traumatol. 2023 Jan-Feb;67(1):3-11. doi: 10.1016/j.recot.2022.08.006. Epub 2022 Aug 13.
Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes.
We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival.
The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times.
Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.
髋关节置换术是老年人群移位型股骨颈骨折的首选治疗方法。髋关节假体脱位是髋关节置换术后最突出的潜在并发症之一，但对于接受半髋关节置换术治疗的老年髋部骨折患者，脱位对其生存的影响缺乏最新信息。我们旨在评估髋部骨折半髋关节置换术后髋关节假体脱位对患者生存结局的独立影响。
我们进行了一项回顾性多中心研究，纳入6631例65岁以上接受半髋关节置换术的股骨颈骨折患者。我们在出院后30天、6周、90天和1年进行随访，确定髋关节脱位率和患者生存率。
女性占78.7%，平均年龄为85.2±6.7岁。出院后前90天髋关节假体脱位发生率为1.9%，占每年记录的原发性脱位的91.54%。我们报告，至少发生一次髋关节假体脱位事件的患者死亡率有统计学显著增加（出院后90天时从16.0%增至24.6%，1年时从29.5%增至44.7%），并且在90天（p=0.016）和1年随访时患者生存功能也显著下降（p<0.001）。复发性脱位事件（26.15%）显示出更高的死亡率（高达60.6%，p<0.001）。多变量Cox回归模型确定假体脱位是影响患者生存的唯一显著变量（p=0.035），使随访1年之前死亡的风险增加2.7倍。
我们的研究表明，在老年人群中，髋部骨折半髋关节置换术后单纯髋关节假体脱位会带来更高的死亡风险。
