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J Orthop Trauma. 2018 May;32(5):223-230. doi: 10.1097/BOT.0000000000001162.

Factors Associated With Revision Surgery After Internal Fixation of Hip Fractures.

Collaborators (548)

Devereaux PJ, Guyatt G, Heetveld MJ, Richardson M, Thabane L, Tornetta P III, Walter SD, McKay P, Scott T, Garibaldi A, Viveiros H, Swinton M, Gichuru M, Buckingham L, Duraikannan A, Maddock D, Simunovic N, Agel J, Heetveld MJ, Van Lieshout EMM, Zielinski SM, Rangan A, Hanusch BC, Kottam L, Clarkson R, Haverlag R, McCormack R, Apostle K, Boyer D, Moola F, Perey B, Stone T, Viskontas D, Lemke HM, Zomar M, Moon K, Moon R, Oatt A, Buckley RE, Duffy P, Korley R, Puloski S, Powell J, Johnston K, Carcary K, Lorenzo M, McKercher R, Sanders D, MacLeod M, Lawendy AR, Tieszer C, Stephen D, Kreder H, Jenkinson R, Nousiainen M, Axelrod T, Murnaghan J, Nam D, Wadey V, Yee A, Milner K, Kunz M, Ghent W, McKee MD, Hall JA, Nauth A, Ahn H, Whelan DB, Vicente MR, Wild LM, Khan RM, Hidy JT, Jennifer T C, Leighton R, Biddulph M, Johnston D, Glazebrook M, Alexander D, Coady C, Dunbar M, Amirault JD, Gross M, Oxner W, Reardon G, Richardson CG, Trenholm JA, Wong I, Trask K, MacDonald S, Dobbin G, Bicknell R, Yach J, Bardana D, Wood G, Harrison M, Yen D, Lambert S, Howells F, Ward A, Zalzal P, Brien H, Naumetz V, Weening B, Simunovic N, Wai EK, Papp S, Gofton WT, Liew A, Kingwell SP, Johnson G, O’Neil J, Roffey DM, Borsella V, Avram V, Oliver TM, Jones V, Vogt M, Jones CB, Ringler JR, Endres TJ, Sietsema DL, Walker JE, Broderick JS, Goetz DR, Pace TB, Schaller TM, Porter SE, Beckish ML, Adams JD, Barden BB, Creek AT, Finley SH, Foret JL, Gudger GK Jr., Gurich RW Jr., Hill AD, Hollenbeck SM, Jackson LT, Kruse KK III, Lackey WG, Langan JW, Lee J, Leffler LC, Miller TJ, Murphy RL Jr., O’Malley LK II, Peters ME, Price DM, Tanksley JA Jr., Torres ET, Watson DJ, Watson ST, Tanner SL, Snider RG, Nastoff LA, Bielby SA, Teasdall RJ, Switzer JA, Cole PA, Anderson SA, Lafferty PM, Li M, Ly TV, Marston SB, Foley AL, Vang S, Wright DM, Marcantonio AJ, Kain MSH, Iorio R, Specht LM, Tilzey JF, Lobo MJ, Garfi JS, Vallier HA, Dolenc A, Breslin M, Prayson MJ, Laughlin R, Rubino LJ, May J, Rieser GR, Dulaney-Cripe L, Gayton C, Shaer J, Schrickel T, Hileman B, Gorczyca JT, Gross JM, Humphrey CA, Kates S, Ketz JP, Noble K, McIntyre AW, Pecorella K, Davis CA, Weinerman S, Weingarten P, Stull P, Lindenbaum S, Hewitt M, Schwappach J, Baker JK, Rutherford T, Newman H, Lieberman S, Finn E, Robbins K, Hurley M, Lyle L, Mitchell K, Browner K, Whatley E, Payton K, Reeves C, Cannada LK, Karges DE, Dawson SA, Sarah A S, Esterhai J, Ahn J, Donegan D, Horan AD, Hesketh PJ, Bannister ER, Keeve JP, Anderson CG, McDonald MD, Hoffman JM, Tarkin I, Siska P, Gruen G, Evans A, Farrell DJ, Irrgang J, Luther A, Cross WW III, Cass JR, Sems SA, Torchia ME, Scrabeck T, Jenkins M, Dumais J, Romero AW, Sagebien CA, Butler MS, Monica JT, Seuffert P, Hsu JR, Stinner D, Ficke J, Charlton M, Napierala M, Fan M, Tornetta P III, Tannoury C, Carlisle H, Silva H, Archdeacon M, Finnan R, Le T, Wyrick J, Hess S, Brennan ML, Probe R, Kile E, Mills K, Clipper L, Yu M, Erwin K, Horwitz D, Strohecker K, Swenson TK, Schmidt AH, Westberg JR, Aurang K, Zohman G, Peterson B, Huff RB, Baele J, Weber T, Edison M, McBeth JC, Shively K, Ertl JP, Mullis B, Parr JA, Worman R, Frizzell V, Moore MM, DePaolo CJ, Alosky R, Shell LE, Hampton L, Shepard S, Nanney T, Cuento C, Cantu RV, Henderson ER, Eickhoff LS, Hammerberg EM, Stahel P, Hak D, Mauffrey C, Henderson C, Gissel H, Gibula D, Zamorano DP, Tynan MC, Pourmand D, Lawson D, Crist BD, Murtha YM, Anderson LK, Linehan C, Pilling L, Lewis CG, Caminiti S, Sullivan RJ, Roper E, Obremskey W, Kregor P, Richards JE, Stringfellow K, Dohm MP, Zellar A, Segers MJM, Zijl JAC, Verhoeven B, Smits AB, de Vries JPPM, Fioole B, van der Hoeven H, Theunissen EBM, de Vries Reilingh TS, Govaert L, Wittich P, de Brauw M, Wille J, Go PMNYM, Ritchie ED, Wessel RN, Hammacher ER, Heetveld MJ, Visser GA, Stockmann H, Silvis R, Snellen JP, Rijbroek B, Scheepers JJG, Vermeulen EGJ, Siroen MPC, Vuylsteke R, Brom HLF, Rijna H, de Rijcke PAR, Koppert CL, Buijk SE, Groenendijk RPR, Dawson I, Tetteroo GWM, Bruijninckx MMM, Doornebosch PG, de Graaf EJR, van der Elst M, van der Pol CC, van ’t Riet M, Karsten TM, de Vries MR, Stassen LPS, Schep NWL, Schmidt GB, Hoffman WH, Poolman RW, Simons MP, van der Heijden FHWM, Willems WJ, de Meulemeester FRAJ, van der Hart CP, Turckan K, Festen S, de Nies F, Haverlag R, Out NJM, Bosma J, van Kampen A, Biert J, van Vugt AB, Edwards MJR, Blokhuis TJ, Frölke JPM, Geeraedts LMG, Gardeniers JWM, Tan ECTH, Poelhekke LMSJ, de Waal Malefijt MC, Schreurs B, Roukema GR, Josaputra HA, Keller P, de Rooij PD, Kuiken H, Boxma H, Cleffken BI, Liem R, Rhemrev SJ, Bosman CHR, van Otterloo AM, Hoogendoorn J, de Vries AC, Meylaerts SAG, Verhofstad MHJ, Meijer J, van Egmond T, van der Heijden FHWM, van der Brand I, Patka P, Eversdijk MG, Peters R, Hartog DD, Van Waes OJF, Oprel P, van der Vis HM, Campo M, Verhagen R, Albers GHR, Zurcher AW, Simmermacher RKJ, van Mulken J, van Wessem K, Blokhuis TJ, van Gaalen SM, Leenen LPH, Bronkhorst MWGA, Guicherit OR, Goslings JC, Haverlag R, Ponsen KJ, Bhatia M, Arora V, Tyagi V, Bedi H, Carr A, Curry H, Chia A, Csongvay S, Donohue C, Doig S, Edwards E, Etherington G, Esser M, Gong A, Jain A, Li D, Miller R, Moaveni A, Russ M, Ton L, Wang O, Dowrick A, Murdoch Z, Sage C, Frihagen F, Clarke-Jenssen J, Hjorthaug G, Ianssen T, Amundsen A, Brattgjerd JE, Borch T, Bøe B, Flatøy B, Hasselund S, Haug KJ, Hemlock K, Hoseth TM, Jomaas J, Kibsgård T, Lona T, Moatshe G, Müller O, Molund M, Nicolaisen T, Nilsen F, Rydinge J, Smedsrud M, Stødle A, Trommer A, Ugland S, Karlsten A, Ekås G, Vesterhus EB, Brekke AC, Gupta A, Jain N, Khan F, Sharma A, Sanghavi A, Trivedi M, Rai A, Rai K, Yadav V, Singh S, Rai K, Tetsworth K, Donald G, Weinrauch P, Pincus P, Yang S, Halliday B, Gervais T, Holt M, Flynn A, Prasad AS, Mishra V, Sundaresh DC, Khanna A, Cherian JJ, Olakkengil DJ, Sharma G, Pirpiris M, Love D, Bucknill A, Farrugia RJ, Pape HC, Knobe M, Pfeifer R, Hull P, Lewis S, Evans S, Nanda R, Logishetty R, Anand S, Bowler C, Dadi A, Palla N, Ganguly U, Rai BS, Rajakumar J, Jennings A, Chuter G, Rose G, Glynis G, Clark C, Eke K, Reed M, Inman D, Herriott C, Dobb C.

Abstract

BACKGROUND:

Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device.

METHODS:

We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation.

RESULTS:

Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal.

CONCLUSIONS:

Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020).

LEVEL OF EVIDENCE:

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

PMID:
29677091
PMCID:
PMC5986292
[Available on 2019-05-01]
DOI:
10.1097/BOT.0000000000001162

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