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Conversion to Arthroplasty After Internal Fixation of Nondisplaced Femoral Neck Fractures: Results from a Swedish Register Cohort of 5,428 Individuals 60 Years of Age or Older
The Journal of Bone & Joint Surgery ( IF 5.3 ) Pub Date : 2023-03-01 , DOI: 10.2106/jbjs.22.01035
Johan Lagergren 1, 2 , Sebastian Mukka 3 , Olof Wolf 4, 5 , Emma Nauclér 6 , Michael Möller 5, 7, 8 , Cecilia Rogmark 6, 9
Affiliation  

Background: 

Although most nondisplaced or minimally displaced femoral neck fractures are routinely treated with internal fixation, high rates of secondary surgical procedures are common, especially in the elderly population. Primary arthroplasty in elderly patients has been proposed as an alternative treatment to reduce the need for a secondary surgical procedure. The objective of this study was to describe the rate of conversion to arthroplasty within 5 years after internal fixation of nondisplaced femoral neck fractures in patients ≥60 years of age.

Methods: 

In this observational cohort study of prospectively collected data from the Swedish Fracture Register (SFR) between 2012 and 2018, cross-matched with the Swedish Arthroplasty Register (SAR), 5,428 nondisplaced femoral neck fractures in patients ≥60 years of age were included. Competing risk analysis was used to estimate conversion rates to arthroplasty and mortality in various age groups at 1, 2, and 5 years.

Results: 

The cumulative incidence function (CIF) for conversion to arthroplasty was 6.3% at 1 year, 8.1% at 2 years, and 10.1% at 5 years. The conversion rates within 2 years were 6.5% in 60 to 69-year-olds, 9.6% in 70 to 79-year-olds, and 7.8% in ≥80-year-olds. Women had a higher risk of conversion; the hazard ratio (HR) was 1.49 (95% confidence interval [CI], 1.19 to 1.87). The cumulative mortality was 21.3% (95% CI, 20.3% to 22.5%) at 1 year, 31.3% (95% CI, 30.0% to 32.6%) at 2 years, and 54.9% (95% CI, 53.1% to 56.7%) at 5 years. Mortality was higher in men at all time points, and the adjusted 1-year HR was 1.79 (95% CI, 1.61 to 2.00).

Conclusions: 

One in 10 patients ≥60 years of age treated with internal fixation for a nondisplaced femoral neck fracture underwent conversion to arthroplasty within 5 years, and more than one-half of the conversions occurred within the first year. The risk of conversion was highest in women and in patients 70 to 79 years of age. These data warrant further studies in this frail patient group to identify subgroups of patients who would benefit from primary arthroplasty for nondisplaced femoral neck fractures.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.



中文翻译:

无移位股骨颈骨折内固定后转为关节成形术:来自瑞典登记队列的结果,该队列由 5,428 名 60 岁或以上的个体组成

背景: 

尽管大多数无移位或轻微移位的股骨颈骨折常规采用内固定治疗,但二次手术的发生率很高,尤其是在老年人群中。老年患者的初次关节置换术已被提议作为替代治疗方法,以减少二次手术的需要。本研究的目的是描述 60 岁以上患者无移位股骨颈骨折内固定后 5 年内转为关节置换术的比率。

方法: 

在这项观察性队列研究中,前瞻性地收集了 2012 年至 2018 年间从瑞典骨折登记处 (SFR) 收集的数据,并与瑞典关节置换术登记处 (SAR) 进行交叉匹配,纳入了 5,428 名年龄≥60 岁的非移位股骨颈骨折患者。使用竞争风险分析来估计不同年龄组 1、2 和 5 岁时的关节置换术转化率和死亡率。

结果: 

转为关节置换术的累积发病率函数 (CIF) 1 年时为 6.3%,2 年时为 8.1%,5 年时为 10.1%。60~69岁人群2年内转化率为6.5%,70~79岁人群2年内转化率为9.6%,80岁以上人群2年内转化率为7.8%。女性皈依的风险较高;风险比 (HR) 为 1.49(95% 置信区间 [CI],1.19 至 1.87)。1 年累积死亡率为 21.3%(95% CI,20.3% 至 22.5%),2 年累积死亡率为 31.3%(95% CI,30.0% 至 32.6%),54.9%(95% CI,53.1% 至 56.7%)。 %) 5 年。在所有时间点,男性的死亡率均较高,调整后的 1 年 HR 为 1.79(95% CI,1.61 至 2.00)。

结论: 

因无移位股骨颈骨折接受内固定治疗的 60 岁以上患者中,十分之一在 5 年内转为关节置换术,其中一半以上的转转发生在第一年内。女性和 70 至 79 岁患者的转化风险最高。这些数据值得在这个虚弱的患者群体中进行进一步的研究,以确定哪些亚组的患者可以从非移位股骨颈骨折的初次关节置换术中受益。

证据级别: 

预后III 级。有关证据级别的完整描述,请参阅作者须知。

更新日期:2023-03-02
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