Background

In Sweden approximately 6000 patients yearly sustain displaced femoral neck fractures. During the last decade there has been a shift towards more arthroplasties at the expense of internal fixation. In 2008 approximately 75% of the dislocated femoral neck fractures in Sweden were treated with arthroplasties. Those patients are typically elderly and frail and the vast majority of them receive hemiarthroplasties. In 2005 a national hemiarthroplasty registration was established as part of the Swedish Hip Arthroplasty Register (SHAR).

Introduction: During the last decade the treatment regime for dislocated femoral neck fractures has switched towards more arthroplasties. There has been apprehensions regarding long-term results for arthroplasties. The opinion has been put forward that preserving the femoral head is preferable to performing total hip arthroplasty.

Methods: 409 of the 450 patients in a randomized study 1995–97 had valid follow-up at 4 months, 1, 2, 5, and 10 years (or until deceased). Mentally intact, independently living and walking patients over 70 years were included and randomized to osteosynthesis (n=217) or arthroplasty (n=192).

Results: After 10 years 168 patients (77 percent) were deceased and there were 99 failures (46 percent) in the osteosynthesis group. In the arthroplasty group 145 patients (76 percent) were deceased and there were 17 failures (9 percent) after 10 years. Both groups had the same rate of failure between 2 and 10 years.

There was significantly better results regarding pain and function in the arthroplasty group at 4 months. At 10 years the results were still not superior for osteosynthesis.

A Cox regression analysis regarding sex, age, time to surgery, smoking, osteoporosis, trauma type, preoperative function and choice of skin incision comparing the patients without hip complications at 10 years with the patients with failures in each group revealed no risk factor for failure.

Discussion: Arthroplasty for hip fracture show a reliable long-term result while osteosynthesis leads to a high rate of complications and is not superior regarding pain and function even when successful. Both methods have the same mortality.

Background: Hemiarthroplasty of the hip is a common procedure, but information about implants and outcome is scarce. In Sweden the number of hemiarthroplasties has increased from 200 in 1998 to 4181 in 2007.

Material and Methods: Nationwide registration started in 2005. 100% of the hospitals participates, and 96% of the hemi-procedures are registrered. An analysis of 12 245 cases operated 2005–07 is presented.

Results: In the Register the mean age at surgery is 84 years (SD 7.0, 73% female). 93% are operated due to acute fracture and 6% due to failed internal fracture fixation. Cemented fixation has been used in 92% and a posterior approach in about half of the cases (52%). The Lubinus and Exeter stems are most common (41 and 23%). The Austin-Moore design has decreased from 9 to 2% during the study period.

3.2% of the patients (hips) have been reoperated, most commonly because of dislocation. Multiple reoperations are common. Male gender, secondary procedure and uncemented stem are associated with increased reoperation risk with 1.2, 1.7 and 1.8 times (1.2, CI: 1.0–1.6; 1.7, 1.3–2.3; 1.8 1.4–2.5). Use of uncemented fixation resulted in increased risk of reoperation, also with exclusion of uncemented Austin-Moore prostheses (1.8 times, 1.1–2.8).

In a separate analysis of the two most frequent designs, use of bipolar head increased the risk of revision twice (1.4–2.8) compared to unipolar head when adjusting for other risk factors. This may reflect that fitter and more active individuals get a bipolar prosthesis and are more prone to become revised should complications occur or a true increase of complications when using bipolar head. A further analysis is in progress.

Use of dorsal approach (1.6, 1.2–2.2), Austin-Moore (1.8, 1.1–3.1) and Thompson prostheses (1.8, 1.5–2.8) increased the risk of revision because of dislocation.

Summary: When treating fracture patients with hemi-arthroplasty we recommend that a well documented cemented implant with different off-set options should be used via an anterolateral approach. Use of bipolar heads may increase the risk of revision.