McMaster University

McMaster University

Outcomes after successful internal fixation versus salvage arthroplasty

We are pleased to share with you a recent publication in the Journal of Orthopaedic Trauma. This publication is entitled "Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture".

Find the abstract below and here to access the full-version of the article.

Zielinski SM, Keijsers NL, Praet SF, Heetveld MJ, Bhandari M, Wilssens JP, Patka P, Van Lieshout EM. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture.J Orthop Trauma. 2014 May 15. [Epub ahead of print]

Abstract

OBJECTIVES:
To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture.

DESIGN:
Secondary cohort study to a randomized controlled trial.

SETTING:
Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals PATIENTS:: Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation.

INTERVENTION:
None (observatory study) MAIN OUTCOME MEASUREMENTS:: Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis.

RESULTS:
Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio -8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median -25.4 versus -20.4 N, P=0.025).

CONCLUSION:
Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture.

 

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