Author/Authors :
HAILER, Nils P Department of Orthopedics - Institute of Surgical Sciences - Uppsala University Hospital, Uppsala , GARLAND, Anne Department of Orthopedics - Visby Hospital, Visby , ROGMARK, Cecilia The Swedish Hip Arthroplasty Register and Department of Orthopedics - Institute of Clinical Sciences - Sahlgrenska Academy - University of Gothenburg, Gothenburg , GARELLICK, Göran The Swedish Hip Arthroplasty Register and Department of Orthopedics - Institute of Clinical Sciences - Sahlgrenska Academy - University of Gothenburg, Gothenburg , KÄRRHOLM, Johan The Swedish Hip Arthroplasty Register and Department of Orthopedics - Institute of Clinical Sciences - Sahlgrenska Academy - University of Gothenburg, Gothenburg
Abstract :
Background and purpose — Early postoperative mortality is
relatively high after total hip arthroplasty (THA) that has been
performed due to femoral neck fracture. However, this has rarely
been investigated after adjustment for medical comorbidity and
comparison with the mortality in an age-matched population. We
therefore assessed early mortality in hip fracture patients treated
with a THA, in the setting of a nationwide matched cohort study.
Patients and methods — 24,699 patients who underwent THA
due to a femoral neck fracture between 1992 and 2012 were
matched with 118,518 controls. Kaplan-Meier survival analysis
was used to calculate cumulative unadjusted survival, and Cox
regression models were fi tted to compute hazard ratios (HRs)
and 95% confi dence intervals (CIs), with adjustment for age, sex,
comorbidity, and socioeconomic background.
Results — 90-day survival was 96.3% (95% CI: 96.0–96.5) for
THA cases and 98.7% (95% CI: 98.6–98.8) for control individu-
als, giving an adjusted HR of 2.2 (95% CI: 2.0–2.4) for THA cases
compared to control individuals. Comorbidity burden increased
in THA cases over time, but the adjusted risk of death within
90 days did not differ statistically signifi cantly between the time
periods investigated (1992–1998, 1999–2005, and 2006–2012). A
Charlson comorbidity index of 3 or more, an American Society
of Anesthesiologists (ASA) grade of 3 and above, male sex, an age
of 80 years and above, an income below the fi rst quartile, and a
lower level of education were all associated with an increased risk
of 90-day mortality.
Interpretation — The adjusted early mortality in femoral neck
fracture patients who underwent THA was about double that in a
matched control population. Patients with femoral neck fracture
but with no substantial comorbidity and an age of less than 80
years appear to have a low risk of early death. Patients older than 80 years and those with a Charlson comorbidity index of more
than 2 have a high risk of early death, and such patients would
perhaps benefi t from treatment strategies other than THA, but
this should be investigated further.
