CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY

James I. Huddleston; Ayushmita De; Heena Jaffri; John W. Barrington; Paul J. Duwelius; Bryan D. Springer

doi:10.1302/1358-992X.2020.10.052

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CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY

The Hip Society (THS) 2020 Members Meeting, held online, 1–2 October 2020.

James I. Huddleston
Ayushmita De
Heena Jaffri
John W. Barrington
Paul J. Duwelius
Bryan D. Springer

CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY

Huddleston JI, De A, Jaffri H, Barrington JW, Duwelius PJ, Springer BD. CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY. Orthop Procs. 2020;102-B(SUPP_10):52-52. doi:10.1302/1358-992X.2020.10.052

Huddleston, James I., et al. “CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY.” Orthopaedic Proceedings, vol. 102-B, no. SUPP_10, 2020, pp. 52-52., https://doi.org/10.1302/1358-992X.2020.10.052

Huddleston, J. I., De, A., Jaffri, H., Barrington, J. W., Duwelius, P. J., & Springer, B. D. (2020). CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY. Orthopaedic Proceedings, 102-B(SUPP_10), 52-52. https://doi.org/10.1302/1358-992X.2020.10.052

Huddleston, J. I., De, A., Jaffri, H., Barrington, J. W., Duwelius, P. J. and Springer, B. D. (2020) “CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY.” Orthopaedic Proceedings, 102-B(SUPP_10), pp. 52-52. Available at: https://doi.org/10.1302/1358-992X.2020.10.052

Huddleston, James I., Ayushmita De, Heena Jaffri, John W. Barrington, Paul J. Duwelius, and Bryan D. Springer. “CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY.” Orthopaedic Proceedings 102-B, no. SUPP_10 (2020): 52-52. https://doi.org/10.1302/1358-992X.2020.10.052

Huddleston JI, De A, Jaffri H, Barrington JW, Duwelius PJ, Springer BD. CEMENTLESS FIXATION, TOTAL HIP ARTHROPLASTY, AND INCREASED AGE ARE RISK FACTORS FOR REVISION AFTER ARTHROPLASTY FOR FEMORAL NECK FRACTURE: RESULTS FROM THE AMERICAN JOINT REPLACEMENT REGISTRY. Orthop Procs. 2020 Oct 1;102-B(SUPP_10):52-52. https://doi.org/10.1302/1358-992X.2020.10.052

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Abstract

Introduction

Patients with FNF may be treated by either total hip arthroplasty (THA) or hemiarthroplasty (HA). Utilizing American Joint Replacement Registry (AJRR) data, we aimed to evaluate outcomes in FNF treatment.

Methods

Medicare patients with FNF treated with HA or THA reported to the AJRR database from 2012–2019 and CMS claims data from 2012–2017 were analyzed in this retrospective cohort study. “Early” was defined as less than 90 days from index procedure. A logistic regression model, including index arthroplasty, age, sex, stem fixation method, hospital size¹, hospital teaching affiliation¹, and Charlson comorbidity index (CCI), was utilized to determine associations between index procedure and revision rates.

Results

Of 75,333 FNF procedures analyzed, 82.2% had HA. 8.4% had cemented fixation. 36.9% had cementless fixation. Fixation was unknown for 41,225 (54.7%) patients. 90-day readmissions rates were 1.3% for both cohorts. Both the early revision rate (0.9% HA vs. 1.3% THA, p<0.0001) as well as the overall revision rate (1.5% HA vs. 2.3% THA, p<0.0001) were higher in the THA cohort. The three most common reasons for any revision were instability (26%), infection (21%), and periprosthetic fracture (15%). Higher rates of any revision were associated with cementless fixation (OR=1.37, 95% CI 1.20–1.57) and increased age (OR=0.96, 95% CI 0.96–0.97). THA and increased age were risk factors for early and any revision for instability. Cementless fixation, female sex, and decreased age were associated with lower revision rates for infection.

Conclusion

The most common surgical treatment for FNF reported to the AJRR was cementless stem fixation and hemiarthroplasty. The higher revision rates for FNF treatment with THA warrant further investigation. The use of cemented femoral fixation in this patient population may be under-utilized. These data provide a benchmark of US practice for reference and comparison to other practices throughout US and the world.