Mortality and complications after total hip arthroplasty via the posterior approach for displaced intracapsular hip fracture: Results from a regional trauma centre.

INTRODUCTION

Total hip arthroplasty (THA) for displaced intracapsular hip fracture is increasingly common. The aim of this project was to determine all-cause mortality rates, rates of significant complications and functional outcomes following THA for fractures.

METHODS

An inpatient database search identified all patients undergoing THA for displaced intracapsular fracture in Northern Ireland's regional trauma centre from 2010-2017. Regional electronic healthcare systems were reviewed for evidence of complications.

RESULTS

After exclusions, 345 cases were identified. The median age was 70 years (31 - 91 years).Median follow-up was 4.3 years (1.6 - 9.3 years). The all-cause mortality rate was 0.3% at 30 days, 3.2% at one year, and 5.5% at two years.Seven patients (2.0%) experienced dislocations. Most occurred within 60 days; five patients underwent revision.Radiographic evidence of heterotopic ossification (HO) was seen in 48 patients (13.8%).Re-operation was required for 16 patients (4.6%). This included 5 dislocations, eight cases of periprosthetic fractures (in seven patients), two cases of infection, and one case of symptomatic HO.Pre-injury, 96.2% (332/345) were independently mobile, and after one year 78.9% (262/332) of those patients remained so. Pre-injury, 96.2% obtained the maximum functional score (Barthel Index, maximum score of 20), and after one year 78.9% (262/332) of these continued to report a maximum Barthel Index score.

CONCLUSION

THA for hip fracture holds a 2.0% risk of dislocation and a 4.6% risk of re-operation. HO is common but seldom requires re-operation. All-cause mortality rates and functional levels compared favourably with current literature.