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The Journal of Hip Surgery 2023; 07(01): 023-029
DOI: 10.1055/s-0042-1760428
Original Article

Postoperative Outcomes of Femoral Neck Fracture Management in Dialysis-Dependent Patients

Elizabeth A. Klag
1   Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Ayooluwa Ayoola
1   Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
2   Department of Orthopedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
,
Mary E. Hennekes 
1   Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Michael A. Charters
1   Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Wayne T. North
1   Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan
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Abstract

Femoral neck fractures are common in patients with chronic kidney disease (CKD) due to abnormalities of bone metabolism. In patients on dialysis, femoral neck fractures have been shown to occur at a younger age than in nondialysis patients. The purpose of this study was to compare the associated complication rates of femoral neck fractures among dialysis patients treated with total hip arthroplasty (THA) versus hemiarthroplasty (HA) as well as evaluate for any differences in outcomes compared to the nondialysis patient population. This was a retrospective cohort study performed using the National Surgical Quality Improvement Program database that included 54,328 patients with femoral neck fractures managed surgically from 2006 to 2016. One-thousand seventy patients were identified as dialysis-dependent. Demographics, medical comorbidities, perioperative complication rates, and mortality rates were collected. Data was first analyzed descriptively and with analysis of variance or chi-squared analyses as appropriate. Odds ratios were then calculated for perioperative outcomes and complications. Femoral neck fractures in patients on dialysis occurred at a significantly younger age (73.3 vs. 77.0, p < 0.001) than nondialysis patients. In dialysis patients who underwent THA, complication rates, postoperative length of stay, readmission rates, and 1-year mortality were greater when compared to nondialysis patients. There were no significant differences in perioperative medical or surgical complication rates within the dialysis population when comparing THA to HA. Dialysis patients treated with THA for femoral neck fracture experience more complications compared to nondialysis patients. However, among dialysis patients treated with THA compared to HA, there were no significant differences in outcomes. THA is, therefore, a viable option for dialysis-dependent patients with femoral neck fractures who are otherwise medically stable.

Keywords

THA - femoral neck fracture - hemiarthroplasty - dialysis - complications


Publication History

Received: 17 August 2022

Accepted: 16 November 2022

Article published online:
06 March 2023

© 2023. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury 2018; 49 (08) 1458-1460
    CrossrefPubMedGoogle Scholar
  • 2 Nandi S, Dougherty P, Gruen G, Ebraheim N. HIP fracture evaluation and management. Adv Orthop 2019; 2019: 2717518
    CrossrefPubMedGoogle Scholar
  • 3 Arshi A, Lai WC, Iglesias BC. et al. Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int 2021; 31 (02) 272-279
    CrossrefPubMedGoogle Scholar
  • 4 Pollmann CT, Røtterud JH, Gjertsen JE, Dahl FA, Lenvik O, Årøen A. Fast track hip fracture care and mortality - an observational study of 2230 patients. BMC Musculoskelet Disord 2019; 20 (01) 248 DOI: 10.1186/s12891-019-2637-6.
    CrossrefPubMedGoogle Scholar
  • 5 Tan J, Li Y, Wu Z, Zhao J. Risk of hip fracture in patients on dialysis or kidney transplant: a meta-analysis of 14 cohort studies. Ther Clin Risk Manag 2018; 14: 1747-1755
    CrossrefPubMedGoogle Scholar
  • 6 Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma 2015; 29 (03) 121-129
    CrossrefPubMedGoogle Scholar
  • 7 Miller BJ, Callaghan JJ, Cram P, Karam M, Marsh JL, Noiseux NO. Changing trends in the treatment of femoral neck fractures: a review of the American Board of Orthopaedic Surgery database. J Bone Joint Surg Am 2014; 96 (17) e149
    CrossrefPubMedGoogle Scholar
  • 8 Burgers PTPW, Hoogendoorn M, Van Woensel EAC. et al; HEALTH Trial Investigators. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study. Osteoporos Int 2016; 27 (06) 1999-2008
    CrossrefPubMedGoogle Scholar
  • 9 Boniello AJ, Lieber AM, Denehy K, Cavanaugh P, Kerbel YE, Star A. National trends in total hip arthroplasty for traumatic hip fractures: an analysis of a nationwide all-payer database. World J Orthop 2020; 11 (01) 18-26
    CrossrefPubMedGoogle Scholar
  • 10 Carroll C, Stevenson M, Scope A, Evans P, Buckley S. Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technol Assess 2011; 15 (36) 1-74
    CrossrefPubMedGoogle Scholar
  • 11 Chen JY, She GR, Luo SM. et al. Hemiarthroplasty compared with internal fixation for treatment of nondisplaced femoral neck fractures in elderly patients: a retrospective study. Injury 2020; 51 (04) 1021-1024
    CrossrefPubMedGoogle Scholar
  • 12 Tol MCJM, van den Bekerom MPJ, Sierevelt IN, Hilverdink EF, Raaymakers ELFB, Goslings JC. Hemiarthroplasty or total hip arthroplasty for the treatment of a displaced intracapsular fracture in active elderly patients: 12-year follow-up of randomised trial. Bone Joint J 2017; 99-B (02) 250-254
    CrossrefPubMedGoogle Scholar
  • 13 Hurwitz EE, Simon M, Vinta SR. et al. Adding examples to the ASA-Physical Status Classification improves correct assignment to patients. Anesthesiology 2017; 126 (04) 614-622
    CrossrefPubMedGoogle Scholar
  • 14 Maravic M, Ostertag A, Torres PU, Cohen-Solal M. Incidence and risk factors for hip fractures in dialysis patients. Osteoporos Int 2014; 25 (01) 159-165
    CrossrefPubMedGoogle Scholar
  • 15 Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 2000; 36 (06) 1115-1121
    CrossrefPubMedGoogle Scholar
  • 16 Arneson TJ, Li S, Liu J, Kilpatrick RD, Newsome BB, St Peter WL. Trends in hip fracture rates in US hemodialysis patients, 1993-2010. Am J Kidney Dis 2013; 62 (04) 747-754
    CrossrefPubMedGoogle Scholar
  • 17 Leinau L, Perazella MA. Hip fractures in end-stage renal disease patients: incidence, risk factors, and prevention. Semin Dial 2006; 19 (01) 75-79
    CrossrefPubMedGoogle Scholar
  • 18 Stein MS, Packham DK, Ebeling PR, Wark JD, Becker GJ. Prevalence and risk factors for osteopenia in dialysis patients. Am J Kidney Dis 1996; 28 (04) 515-522
    CrossrefPubMedGoogle Scholar
  • 19 Kim SM, Liu S, Long J, Montez-Rath ME, Leonard MB, Chertow GM. Declining rates of hip fracture in end-stage renal disease: analysis from the 2003–2011 Nationwide Inpatient Sample. J Bone Miner Res 2017; 32 (11) 2297-2303
    CrossrefPubMedGoogle Scholar
  • 20 Hickson LJ, Farah WH, Johnson RL. et al. Death and postoperative complications after hip fracture repair: dialysis effect. Kidney Int Rep 2018; 3 (06) 1294-1303
    CrossrefPubMedGoogle Scholar
  • 21 Lin SJ, Chen TH, Kuo LT, Yu PA, Chen CL, Hsu WH. Effects of Chronic Kidney Disease on Hemiarthroplasty Outcomes for Fragility Hip Fracture in Diabetic Patients: A Nationwide Population-Based Observational Study. J Arthroplasty 2020; 35 (02) 477-484.e4
    CrossrefPubMedGoogle Scholar
  • 22 Puvanesarajah V, Amin R, Qureshi R. et al. Outcomes following surgical management of femoral neck fractures in elderly dialysis-dependent patients. Arch Orthop Trauma Surg 2018; 138 (06) 757-764
    CrossrefPubMedGoogle Scholar
  • 23 Ponnusamy KE, Jain A, Thakkar SC, Sterling RS, Skolasky RL, Khanuja HS. Inpatient mortality and morbidity for dialysis-dependent patients undergoing primary total hip or knee arthroplasty. J Bone Joint Surg Am 2015; 97 (16) 1326-1332
    CrossrefPubMedGoogle Scholar
  • 24 Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome analysis of hemiarthroplasty vs. total hip replacement in displaced femoral neck fractures in the elderly. J Clin Diagn Res 2016; 10 (05) RC11-RC13
    CrossrefPubMedGoogle Scholar
  • 25 Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-matched, population-based study. J Bone Joint Surg Am 2019; 101 (07) 572-579
    CrossrefPubMedGoogle Scholar
  • 26 Jameson SS, Lees D, James P. et al. Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data. Injury 2013; 44 (12) 1940-1944
    CrossrefPubMedGoogle Scholar
  • 27 Lewis DP, Wæver D, Thorninger R, Donnelly WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty 2019; 34 (08) 1837-1843.e2
    CrossrefPubMedGoogle Scholar
  • 28 Liodakis E, Antoniou J, Zukor DJ, Huk OL, Epure LM, Bergeron SG. Major complications and transfusion rates after hemiarthroplasty and total hip arthroplasty for femoral neck fractures. J Arthroplasty 2016; 31 (09) 2008-2012
    CrossrefPubMedGoogle Scholar
  • 29 Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 2010; 340: c2332
    CrossrefPubMedGoogle Scholar
  • 30 Suarez JC, Arguelles W, Saxena A, Rivera P, Parris D, Veledar E. Hemiarthroplasty vs total hip arthroplasty for femoral neck fractures: 2010–2017 trends in complication rates. J Arthroplasty 2020; 35 (6S): S262-S267
    CrossrefPubMedGoogle Scholar