Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck

Author:

Mahmoud S. S. S.1,Pearse E. O.2,Smith T. O.3,Hing C. B.2

Affiliation:

1. Health Education North East South Tees NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK.

2. St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, SW17 0QT, London, UK.

3. University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.

Abstract

Aims The optimal management of intracapsular fractures of the femoral neck in independently mobile patients remains open to debate. Successful fixation obviates the limitations of arthroplasty for this group of patients. However, with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip arthroplasty (THA) must be considered. We carried out a systematic review to compare the outcomes of salvage THA and primary THA for intracapsular fractures of the femoral neck. Patients and Methods We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) compliant systematic review, using the PubMed, EMBASE and Cochrane libraries databases. A meta-analysis was performed where possible, and a narrative synthesis when a meta-analysis was not possible. Results Our analyses revealed a significantly increased risk of complications including deep infection, early dislocation and peri-prosthetic fracture with salvage THA when compared with primary THA for an intracapsular fracture of the femoral neck (overall risk ratio of 3.15). Functional outcomes assessment using EuroQoL (EQ)-5D were not significantly different (p = 0.3). Conclusion Salvage THA carries a significantly higher risk of complications than primary THA for intracapsular fractured neck of femur. Current literature is still lacking well designed studies to provide a full answer to the question. Take home message: Salvage THA is associated with more complications than primary THA for intracapsular neck of femur fractures. Cite this article: Bone Joint J 2016;98-B:452–60.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

Reference29 articles.

1. No authors listed. National Hip Fracture Database National report 2014. http://www.nhfd.co.uk/2014report (last day accessed 03November 2015).

2. No authors listed. National Hip Fracture Database National report 2013. http://www.nhfd.co.uk/2013 report (date last accessed 03 November 2015).

3. No authors listed. The management of hip fracture in adults. http://pathways.nice.org.uk/pathways/hip-fracture#path=view%3A/pathways/hip-fracture/hip-fracture-overview.xml& content=view-index (last accessed 17 February 2016).

4. The effect of middle-age body weight and physical activity on the risk of early revision hip arthroplasty: A cohort study of 1,535 individuals

5. Risk Factors for Nonunion in Patients with Intracapsular Femoral Neck Fractures Treated with Three Cannulated Screws Placed in Either a Triangle or an Inverted Triangle Configuration

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