Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Authors

Sheila Sprague, McMaster University
Emil H. Schemitsch, Western University
Marc Swiontkowski, University of Minnesota Twin Cities
Gregory J. Della Rocca, University of Missouri
Kyle J. Jeray, Greenville Hospital System
Susan Liew
Gerard P. Slobogean, University of Maryland School of Medicine
Sofia Bzovsky, McMaster University, Faculty of Health Sciences
Diane Heels-Ansdell, McMaster University
Qi Zhou, McMaster University
Mohit Bhandari, McMaster University
Sheila Sprag, McMaster University, Faculty of Health Sciences
P. J. Devereaux, McMaster University
Gordon Guyatt, McMaster University
Martin J. Heetveld, Spaarne Gasthuis
Martin Richardson, University of Melbourne
Lehana Thabane, McMaster University
Paul Tornetta, Boston University Medical Center
Stephen D. Walter, McMaster University
Paula McKay
Taryn Scott
Alisha Garibaldi
Helena Viveiros
Marilyn Swinton
Mark Gichuru
Lisa Buckingham
Aravin Duraikannan
Deborah Maddock, McMaster University
Nicole Simunovic, McMaster University
Julie Agel, University of Minnesota Twin Cities
Esther M.M. Van Lieshout
Stephanie M. Zielinski, Erasmus MC
Amar Rangan

Document Type

Conference Proceeding

Publication Date

5-1-2018

Journal

Journal of Orthopaedic Trauma

Volume

32

Issue

5

First Page

223

Last Page

230

URL with Digital Object Identifier

10.1097/BOT.0000000000001162

Abstract

© 2018 Wolters Kluwer Health, Inc. All rights reserved. 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).