Do Dual-mobility Cups Reduce Revision Risk in Femoral Neck Fractures Compared With Conventional THA Designs? An International Meta-analysis of Arthroplasty Registries.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. 20. Acta Orthop. 2012 Oct;83(5):493-8. doi: 10.3109/17453674.2012.688724. Epub 2012 May 10. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Enocson A(1), Mattisson L, Ottosson C, Lapidus LJ. Author information: (1)Orthopaedic Unit, Department of Clinical Science and Education, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden. anders.enocson@sodersjukhuset.se BACKGROUND AND PURPOSE: Hip arthroplasty is an option for elderly patients with osteoporosis for the treatment of failure after fixation of trochanteric and subtrochanteric fractures, either as a total hip arthroplasty (THA) or as a hemiarthroplasty (HA). We analyzed the reoperation rate and risk factors for reoperation in a consecutive series of patients. METHODS: All patients (n = 88) operated from 1999 to 2006 with a THA (n = 63) or an HA (n = 25) due to failure of fixation of a trochanteric fracture (n = 63) or subtrochanteric fracture (n = 25) were included. Background data were collected from the patient records. A search was performed in the national registry of the Swedish National Board of Health and Welfare in order to find information on all reoperations. The follow-up time was 5-11 years. RESULTS: The reoperation rate was 16% (14/88 hips). A periprosthetic fracture occurred in 6 patients, a deep prosthetic infection in 5 patients, and a dislocation of the prosthesis in 3 patients. Standard-length femoral stems had an increased risk of reoperation (11/47) compared to long stems (3/41) (HR = 4, 95% CI: 1.0-13; p = 0.06). INTERPRETATION: The high reoperation rate reflects the complexity of the surgery. Using long femoral stems that bridge previous holes and defects may be one way to reduce the risk for reoperation. DOI: 10.3109/17453674.2012.688724 PMCID: PMC3488176