THA, hemiarthoplasty are effective for low-energy displaced femoral neck fractures
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With low revision and reoperation rates, both total hip arthroplasty and hemiarthroplasty are effective procedures for patients older than 50 years with low-energy displaced femoral neck fractures, according to presented results.
Michael Blankstein, MD, MSc, FRCSC, a trauma and arthroplasty surgeon and assistant professor at the University of Vermont Medical Center, presented findings of his hip fracture evaluations with alternatives of THA vs. hemiarthroplasty (HEALTH) trial at the Orthopaedic Trauma Association Annual Meeting. The meeting was held virtually.
“The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after sustaining a hip fracture,” he said in his presentation.
According to the study, Blankstein and colleagues assessed patient factors including age, BMI, major comorbidities and independent ambulation, as well as surgeon factors including length of operation, surgical approach, femoral component cementation, femoral head size and degree of femoral stem offset.
“As we all know, femoral head size may affect stability. [Femoral head size] may affect the arc of motion, jump distance and head-to-neck ratio,” Blankstein said. “A high offset stem may improve soft tissue tension in the abductor lever arm and that may be related to dislocations. We also know that cemented stems may decrease the risk of periprosthetic fractures; however, they may increase the rates of fat embolism. And lastly, we know that surgical approach may affect dislocation rate, as well as patient’s gait and limp,” he added.
Blankstein and colleagues included 1,441 patients with mean age of 79 years who were undergoing either THA or hemiarthroplasty. Blankstein also noted 70% of patients in the analysis were women.
According to study results, two-thirds of the procedures were performed with a cemented femoral stem. The most common surgical approach was a lateral approach, which was used in 65.5% of cases. Additionally, 32 mm heads were used in most cases (54%) and high-offset femoral stems were implanted in 18% of cases.
“To our surprise, none of the studied factors were found to be predictors of revision surgery,” Blankstein said. However, he noted the low overall revision rate could have limited the ability of the study to detect predictive factors for revision surgery.
“Both THA and hemiarthroplasty are successful procedures with low reoperation rates when treating patients with low-energy displaced femoral neck fractures,” he said. “The patients in the study were predominately elderly females, and one [could] not generalize our findings to an active, younger, femoral neck fracture population,” he added.
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Blankstein M, et al. What factors increase revision surgery risk when treating displaced femoral neck fractures with arthroplasty: a secondary analysis of the HEALTH trial. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20-24, 2020 (virtual meeting).
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