Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

Stephanie M. Zielinski; Noël L Keijsers; Stephan F E Praet; Martin J. Heetveld; Mohit Bhandari; Jean Pierre Wilssens; Peter Patka; Esther M M Van Lieshout

doi:10.1097/BOT.0000000000000123

Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

Stephanie M. Zielinski, Noël L Keijsers, Stephan F E Praet, Martin J. Heetveld, Mohit Bhandari, Jean Pierre Wilssens, Peter Patka, Esther M M Van Lieshout,

Research output: Contribution to journal › Article › Academic › peer-review

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 nonacademic 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 Western Ontario McMaster osteoarthritis index 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 Western Ontario McMaster osteoarthritis index score (median, 73 vs. 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 vs. 0.4, P = 0.013) and a significant greater loss of abduction strength (median, -25.4 vs. -20.4 N, P = 0.025).

CONCLUSIONS: 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.

LEVEL OF EVIDENCE: Therapeutic level III.

Original language	English
Pages (from-to)	e273-80
Journal	Journal of Orthopaedic Trauma
Volume	28
Issue number	12
DOIs	https://doi.org/10.1097/BOT.0000000000000123
Publication status	Published - Dec 2014

Keywords

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Cohort Studies
Femoral Neck Fractures
Fracture Fixation, Internal
Gait
Humans
Leg Length Inequality
Middle Aged
Muscle Strength
Quality of Life
Recovery of Function
Reoperation
Salvage Therapy
Treatment Outcome
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Access to Document

10.1097/BOT.0000000000000123

Cite this

@article{c42b8bd28da24971bb7476828dd33310,

title = "Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture",

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 nonacademic 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 Western Ontario McMaster osteoarthritis index 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 Western Ontario McMaster osteoarthritis index score (median, 73 vs. 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 vs. 0.4, P = 0.013) and a significant greater loss of abduction strength (median, -25.4 vs. -20.4 N, P = 0.025).CONCLUSIONS: 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.LEVEL OF EVIDENCE: Therapeutic level III.",

keywords = "Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip, Cohort Studies, Femoral Neck Fractures, Fracture Fixation, Internal, Gait, Humans, Leg Length Inequality, Middle Aged, Muscle Strength, Quality of Life, Recovery of Function, Reoperation, Salvage Therapy, Treatment Outcome, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't",

author = "Zielinski, {Stephanie M.} and Keijsers, {No{\"e}l L} and Praet, {Stephan F E} and Heetveld, {Martin J.} and Mohit Bhandari and Wilssens, {Jean Pierre} and Peter Patka and {Van Lieshout}, {Esther M M} and {van Wessem}, KJP",

year = "2014",

month = dec,

doi = "10.1097/BOT.0000000000000123",

language = "English",

volume = "28",

pages = "e273--80",

journal = "Journal of Orthopaedic Trauma",

issn = "0890-5339",

publisher = "Lippincott Williams & Wilkins",

number = "12",

}

TY - JOUR

T1 - Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

AU - Zielinski, Stephanie M.

AU - Keijsers, Noël L

AU - Praet, Stephan F E

AU - Heetveld, Martin J.

AU - Bhandari, Mohit

AU - Wilssens, Jean Pierre

AU - Patka, Peter

AU - Van Lieshout, Esther M M

AU - van Wessem, KJP

PY - 2014/12

Y1 - 2014/12

N2 - 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 nonacademic 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 Western Ontario McMaster osteoarthritis index 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 Western Ontario McMaster osteoarthritis index score (median, 73 vs. 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 vs. 0.4, P = 0.013) and a significant greater loss of abduction strength (median, -25.4 vs. -20.4 N, P = 0.025).CONCLUSIONS: 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.LEVEL OF EVIDENCE: Therapeutic level III.

AB - 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 nonacademic 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 Western Ontario McMaster osteoarthritis index 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 Western Ontario McMaster osteoarthritis index score (median, 73 vs. 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 vs. 0.4, P = 0.013) and a significant greater loss of abduction strength (median, -25.4 vs. -20.4 N, P = 0.025).CONCLUSIONS: 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.LEVEL OF EVIDENCE: Therapeutic level III.

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Hip

KW - Cohort Studies

KW - Femoral Neck Fractures

KW - Fracture Fixation, Internal

KW - Gait

KW - Humans

KW - Leg Length Inequality

KW - Middle Aged

KW - Muscle Strength

KW - Quality of Life

KW - Recovery of Function

KW - Reoperation

KW - Salvage Therapy

KW - Treatment Outcome

KW - Journal Article

KW - Randomized Controlled Trial

KW - Research Support, N.I.H., Extramural

KW - Research Support, Non-U.S. Gov't

U2 - 10.1097/BOT.0000000000000123

DO - 10.1097/BOT.0000000000000123

M3 - Article

C2 - 24835623

SN - 0890-5339

VL - 28

SP - e273-80

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

IS - 12

ER -

Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

Abstract

Keywords

Access to Document

Fingerprint

Cite this