Hoehmann Christopher L, Mubin Nailah F, Hinnenkamp Glyn, Modica Edward J, Eckardt Patricia A, Cuellar John C
Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York.
Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York.
J Arthroplasty. 2024 Mar;39(3):708-715. doi: 10.1016/j.arth.2023.09.030. Epub 2023 Sep 29.
Although a rare complication, dislocation following hemiarthroplasty (HA) for a femoral neck hip fracture is associated with increased mortality, readmission, and possible revision surgery. To date many of the specific risk factors have been difficult to demonstrate. Patient factors, surgical factors, as well as morphological factors need to be assessed. Therefore, the purpose of this study was to elucidate the risk factors for dislocation of HA following femoral neck hip fractures in the geriatric population.
This was a retrospective review of 270 patients who had hip fractures. Medical records between the years 2016 and 2022 informed binomial regression predictive models. The discriminative ability of variables in the final model and acetabular anteversion to predict dislocation was assessed with area under the curve (AUC) estimates.
Center edge angle (odds ratio 1.23), abduction angle (odds ratio 1.17), and depth width ratio (2.96) were significant predictors of dislocation (P = .003, .028, and <.001, respectively). Center edge angle and depth width ratio (<44.1 ° and .298), respectively, were cut scores for risk. Dementia had a high discriminative of ability, as did men (AUC = 0.617, 0.558, respectively). Acetabular anteversion was not predictive of dislocation (P = .259) and theorized anteversion safe zones had poor discriminative ability with AUCs of 0.510 and 0.503, respectively.
Morphological factors related to hip dysplasia and a shallow acetabulum, which can be assessed with a radiograph alone, were found to be predictors of instability following HA in the elderly. Hemiarthroplasty implant design and manufacturer, and also acetabular version did not contribute to instability risk.
尽管半髋关节置换术（HA）治疗股骨颈髋部骨折后脱位是一种罕见的并发症，但它与死亡率增加、再入院以及可能的翻修手术有关。迄今为止，许多具体的危险因素难以证实。需要评估患者因素、手术因素以及形态学因素。因此，本研究的目的是阐明老年人群股骨颈髋部骨折后HA脱位的危险因素。
这是一项对270例髋部骨折患者的回顾性研究。2016年至2022年期间的病历为二项式回归预测模型提供了信息。使用曲线下面积（AUC）估计值评估最终模型中的变量和髋臼前倾角预测脱位的判别能力。
中心边缘角（优势比为1.23）、外展角（优势比为1.17）和深度宽度比（2.96）是脱位的显著预测因素（P分别为0.003、0.028和<0.001）。中心边缘角和深度宽度比（分别<44.1°和0.298）是风险的截断分数。痴呆症和男性具有较高的判别能力（AUC分别为0.617和0.558）。髋臼前倾角不能预测脱位（P = 0.259），理论上的前倾角安全区判别能力较差，AUC分别为0.510和0.503。
发现与髋关节发育不良和髋臼浅相关的形态学因素可单独通过X线片评估，是老年人HA术后不稳定的预测因素。半髋关节置换植入物的设计和制造商以及髋臼版本与不稳定风险无关。
