Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

on behalf of the FAITH Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

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).

Original languageEnglish (US)
Pages (from-to)223-230
Number of pages8
JournalJournal of orthopaedic trauma
Volume32
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Hip Fractures
Reoperation
Confidence Intervals
Hip
Femoral Neck Fractures
Arthroplasty
Internal Fixators
Hemiarthroplasty
Sex Ratio
Body Mass Index
Pain
Infection

Keywords

  • cancellous screws
  • femoral neck fracture
  • internal fixation
  • revision surgery
  • sliding hip screw

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

Cite this

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures. / on behalf of the FAITH Investigators.

In: Journal of orthopaedic trauma, Vol. 32, No. 5, 01.05.2018, p. 223-230.

Research output: Contribution to journalArticle

on behalf of the FAITH Investigators. / Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures. In: Journal of orthopaedic trauma. 2018 ; Vol. 32, No. 5. pp. 223-230.
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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).",
keywords = "cancellous screws, femoral neck fracture, internal fixation, revision surgery, sliding hip screw",
author = "{on behalf of the FAITH Investigators} and Sheila Sprague and Schemitsch, {Emil H.} and Marc Swiontkowski and {Della Rocca}, {Gregory J.} and Jeray, {Kyle J.} and Susan Liew and Swiontkowski, {Marc F} and Sofia Bzovsky and Diane Heels-Ansdell and Qi Zhou and Mohit Bhandari and Sheila Sprag and Devereaux, {P. J.} and Gordon Guyatt and Heetveld, {Martin J.} and Martin Richardson and Lehana Thabane and Paul Tornetta and Walter, {Stephen D.} and Paula McKay and Taryn Scott and Alisha Garibaldi and Helena Viveiros and Marilyn Swinton and Mark Gichuru and Lisa Buckingham and Aravin Duraikannan and Deborah Maddock and Nicole Simunovic and Julie Agel and {Van Lieshout}, {Esther M.M.} and Zielinski, {Stephanie M.} and Amar Rangan and Hanusch, {Birgit C.} and Lucksy Kottam and Rachel Clarkson and Robert Haverlag and Robert McCormack and Kelly Apostle and Dory Boyer and Farhad Moola and Bertrand Perey and Trevor Stone and Darius Viskontas and Lemke, {H. Michael} and Mauri Zomar and Switzer, {Julie A} and Cole, {Peter A} and Lafferty, {Paul M} and Marston, {Scott B}",
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T1 - Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

AU - on behalf of the FAITH Investigators

AU - Sprague, Sheila

AU - Schemitsch, Emil H.

AU - Swiontkowski, Marc

AU - Della Rocca, Gregory J.

AU - Jeray, Kyle J.

AU - Liew, Susan

AU - Swiontkowski, Marc F

AU - Bzovsky, Sofia

AU - Heels-Ansdell, Diane

AU - Zhou, Qi

AU - Bhandari, Mohit

AU - Sprag, Sheila

AU - Devereaux, P. J.

AU - Guyatt, Gordon

AU - Heetveld, Martin J.

AU - Richardson, Martin

AU - Thabane, Lehana

AU - Tornetta, Paul

AU - Walter, Stephen D.

AU - McKay, Paula

AU - Scott, Taryn

AU - Garibaldi, Alisha

AU - Viveiros, Helena

AU - Swinton, Marilyn

AU - Gichuru, Mark

AU - Buckingham, Lisa

AU - Duraikannan, Aravin

AU - Maddock, Deborah

AU - Simunovic, Nicole

AU - Agel, Julie

AU - Van Lieshout, Esther M.M.

AU - Zielinski, Stephanie M.

AU - Rangan, Amar

AU - Hanusch, Birgit C.

AU - Kottam, Lucksy

AU - Clarkson, Rachel

AU - Haverlag, Robert

AU - McCormack, Robert

AU - Apostle, Kelly

AU - Boyer, Dory

AU - Moola, Farhad

AU - Perey, Bertrand

AU - Stone, Trevor

AU - Viskontas, Darius

AU - Lemke, H. Michael

AU - Zomar, Mauri

AU - Switzer, Julie A

AU - Cole, Peter A

AU - Lafferty, Paul M

AU - Marston, Scott B

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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).

AB - 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).

KW - cancellous screws

KW - femoral neck fracture

KW - internal fixation

KW - revision surgery

KW - sliding hip screw

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