Zhang Zhichang, Ma Chao, Chi Jialun, Cui Quanjun, Duensing Ian M
Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China; Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China.
J Arthroplasty. 2025 Mar;40(3):683-687.e1. doi: 10.1016/j.arth.2024.09.017. Epub 2024 Sep 16.
Dementia poses an elevated risk of femoral neck fracture (FNF) in the elderly, often leading to the need for hemiarthroplasty. Yet, the outcomes of hemiarthroplasty in patients who have dementia remain uncertain. The purpose of this study was to assess whether dementia serves as a potential risk factor for outcomes following hemiarthroplasty.
Dementia patients who underwent hemiarthroplasty for FNF with at least 1 year of follow-up were identified using a national insurance database. A 1:1 matched control cohort of patients who do not have dementia was created for comparison. Logistic regression analyses were used to evaluate the rates of complications between the two cohorts. A total of 89,072 patients, of whom half have dementia and half do not, undergoing hemiarthroplasty for FNF were identified.
Aside from increased risks of medical complications (P < 0.01), including pneumonia, cerebrovascular accident, acute kidney injury, urinary tract infection, and sepsis, within 90 days, dementia patients also demonstrated higher rates of surgical complications within 1 year, such as dislocation (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.71 to 2.04), periprosthetic fractures (OR 1.29, 95% CI 1.16 to 1.45), and revision (OR 1.23, 95% CI 1.10 to 1.36). On the other hand, dementia patients displayed slightly reduced rates of 90-day deep vein thrombosis and pulmonary embolism. However, no significant increase was found in transfusion, myocardial infarction, wound complications, periprosthetic joint infection, or aseptic loosening between the two cohorts. Additionally, patients who have dementia demonstrated a higher likelihood of 90-day emergency department visits, whereas rates of 90-day hospital readmission remained similar.
Although dementia patients do not exhibit an elevated risk of periprosthetic joint infection, or aseptic loosening, they are more prone to experiencing higher risks of prosthetic dislocation, periprosthetic fracture, and revision. Furthermore, specific medical complications tend to be more prevalent among individuals who have dementia.
痴呆症会增加老年人股骨颈骨折（FNF）的风险，常导致需要进行半髋关节置换术。然而，痴呆症患者接受半髋关节置换术的效果仍不确定。本研究的目的是评估痴呆症是否是半髋关节置换术后预后的潜在风险因素。
使用国家保险数据库识别接受FNF半髋关节置换术且至少随访1年的痴呆症患者。创建一个1:1匹配的无痴呆症患者对照队列进行比较。采用逻辑回归分析评估两组之间的并发症发生率。共识别出89072例接受FNF半髋关节置换术的患者，其中一半患有痴呆症，一半没有。
除了90天内医疗并发症风险增加（P<0.01），包括肺炎、脑血管意外、急性肾损伤、尿路感染和败血症外，痴呆症患者在1年内手术并发症发生率也较高，如脱位（优势比（OR）1.87，95%置信区间（CI）1.71至2.04）、假体周围骨折（OR 1.29，95%CI 1.16至1.45）和翻修（OR 1.23，95%CI 1.10至1.36）。另一方面，痴呆症患者90天深静脉血栓形成和肺栓塞发生率略有降低。然而，两组之间在输血、心肌梗死、伤口并发症、假体周围关节感染或无菌性松动方面未发现显著增加。此外，患有痴呆症的患者90天内急诊就诊的可能性更高，而90天内再次入院率保持相似。
虽然痴呆症患者假体周围关节感染或无菌性松动的风险没有增加，但他们更容易发生假体脱位、假体周围骨折和翻修的较高风险。此外，特定的医疗并发症在患有痴呆症的个体中往往更普遍。
