When and where do hip fractures occur? A population-based study

Summary

We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between community dwellers and residential care facility dwellers, and in relation to subjects’ psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days.

Introduction

This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground.

Methods

We consecutively included 484 incident hip fracture events (age ≥50 years) admitted to a Swedish orthopedic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in-patient medical records and through patient or caregiver interviews.

Results

The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95 % confidence interval (CI), 1.12–4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95 % CI, 1.40–6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95 % CI, 1.02–1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors.

Conclusions

Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted.     

Hemoglobin and hip fracture risk in older non-Hispanic white adults

Summary

The relationship between hemoglobin and hip fracture was examined in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III). Both low and high hemoglobin values were associated with increased hip fracture risk before and after adjusting for selected risk factors.

Introduction

The few studies to date that have examined the relationship between hemoglobin and fracture risk have focused on low hemoglobin values. The present study examined hip fracture risk across the hemoglobin distribution in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III, 1988–1994).

Methods

Hemoglobin was measured using a Coulter S-plus Jr.® (Coulter Electronics, Hialeah, FL) in 2,122 non-Hispanic whites age 65 years and older. Hip fracture cases were identified using linked Medicare and mortality records obtained through 2007. Cox proportional hazards models were used to assess the best-fitting model and to estimate the hazards ratio (HR) for hip fracture by hemoglobin decile before and after adjusting for selected confounders.

Results

There were 239 hip fracture cases in the analytic sample. The best fitting model was quadratic. When compared to values in the middle of the distribution, those with hemoglobin in the lowest and highest deciles had increased hip fracture risk (HR_{lowest decile}?=?2.96, 95 % confidence interval (CI) 1.44–6.08; HR_{highest decile}?=?2.06, 95 % CI 1.09–3.92) after adjusting for age and sex. Both HRs remained significant after adjusting for additional confounders (HR_{lowest decile}?=?2.24, 95 % CI 1.09–3.92; HR_{highest decile}?=?2.37, 95 % CI 1.35–4.16).

Conclusions

Both low and high hemoglobin values were associated with increased hip fracture risk. The mechanism underlying the relationship is not clear, but there were some suggestions that it may differ for low versus high hemoglobin.     

The incidence of a first major osteoporotic fracture in Iceland and implications for FRAX

Summary

Based on an extensive cohort study over 25 years, the present study supports the assumption that major osteoporotic fractures can be reasonably predicted from hip fracture rates.

Introduction

The construct for FRAX models depends on algorithms to adjust for double counting of fracture outcomes in some models and in others, to estimate the incidence of a major fracture from hip fracture rates. The aim of the present study was to test the validity of these algorithms in a large prospective cohort.

Methods

The incidence of hip, clinical spine, distal forearm, and humerus fracture was determined in the prospective and ongoing population-based Reykjavik Study with follow up of 257,001 person-years. The incidence of a first major fracture was compared with the correction factors used in FRAX to adjust the incidence of several fracture outcomes for double counting. In addition, the incidence of a major osteoporotic fracture estimated from the Icelandic hip fracture rates was compared with the Malmo ratios used in FRAX.

Results

The adjustments necessary to account for multiple fracture outcomes were similar to those previously derived from Sweden. Additionally, incidence of a first major osteoporotic fracture was similar to that derived for FRAX models.

Conclusion

The findings of the present study support the algorithms used in FRAX to estimate the incidence of a first major fracture and the predictive value of hip fracture for other major fractures.     

The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000–2010

Summary

The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4 % of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5 % after 5 years. Subsequent fracture rates increased during the study period both for major and any (non-hip) fracture.

Introduction

Hip fractures are associated with subsequent fractures, particularly in the year following initial fracture. Age-adjusted hip fracture rates have stabilised in many developed countries, but secular trends in subsequent fracture remain poorly documented. We thus evaluated secular trends (2000–2010) and determinants for the risk of a subsequent major (humerus, vertebral, or forearm) and any (non-hip) fracture after hip fracture.

Methods

Patients ≥50 years with a hip fracture between 2000 and 2010 were extracted from the UK Clinical Practice Research Datalink (n?=?30,516). Incidence rates, cumulative incidence probabilities, and adjusted hazard ratios (aHRs) were calculated.

Results

Within 1 year following hip fracture, 2.7 and 8.4 % of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5 % after 5 years, respectively. The most important risk factors for a subsequent major fracture within 1 year were the female gender [aHR 1.90, 95 % confidence interval (CI) 1.51–2.40] and a history of secondary osteoporosis (aHR 1.54, 95 % CI 1.17–2.02). The annual risk increased during the study period for both subsequent major (2009–2010 vs. 2000–2002: aHR 1.44, 95 % CI 1.12–1.83) and any (non-hip) facture (2009–2010 vs. 2000–2002: aHR 1.80, 95 % CI 1.58–2.06).

Conclusion

The risk of sustaining a major or any (non-hip) fracture after hip fracture is small in the first year. However, given the recent rise in secondary fracture rates and the substantial risk of subsequent fracture in the longer term, fracture prevention is clearly indicated for patients who have sustained a hip fracture.     

Does diabetes modify the effect of FRAX risk factors for predicting major osteoporotic and hip fracture?

Summary

In an observational study population of 62,413 individuals (6,455 [10 %] with diabetes), diabetes was independently associated with major osteoporotic fractures (MOFs) but did not significantly modify the effect of FRAX^TM risk factors or prior fracture site. However, the presence of diabetes exerted a much stronger effect on hip fracture risk in younger versus older individuals.

Introduction

Diabetes mellitus increases fracture risk independent of risk factors that comprise the WHO FRAX^TM tool. We explored whether diabetes modifies the effect of FRAX clinical risk factors on MOF and hip fracture risk.

Methods

Using a registry of clinical dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified women and men aged 40 years and older undergoing baseline DXA in 1996–2011. Health services data were used to identify diabetes diagnosis, FRAX risk factors and incident fractures using previously validated algorithms. Prior fracture was stratified as clinical vertebral, hip, humerus, forearm, pelvis and ‘other’. Cox proportional hazards models were used to test for statistical interactions of diabetes with FRAX clinical risk factors and prior fracture site.

Results

During a mean follow-up of 6 years, there were 4,218 MOF and 1,108 hip fractures. Diabetes was a significant independent risk factor for MOF adjusted for FRAX risk factors including bone mineral density (BMD) (adjusted hazard ratio [aHR] 1.32 [95 % confidence interval (CI) 1.20–1.46]). No significant interactions of FRAX risk factors or prior fracture site with diabetes were identified in analyses of MOF. For predicting hip fractures, age significantly modified the effect of diabetes (aHR age <60, 4.67 [95 % CI 2.76–7.89], age 60–69, 2.68 [1.77–4.04], age 70–79, 1.57 [1.20–2.04], age >80, 1.42 [1. 10–1.99]; pinteraction <0.001).

Conclusions

Diabetes is an independent risk factor for MOFs and does not significantly modify the effect of FRAX risk factors or prior fracture site. However, diabetes exerts a much stronger effect on hip fracture risk in younger than older individuals which needs to be considered in hip fracture prediction.     

FRAX provides robust fracture prediction regardless of socioeconomic status

Summary

We investigated the fracture risk assessment tool (FRAX) Canada calibration and discrimination according to income quintile in 51,327 Canadian women, with and without a competing mortality framework. Our data show that, under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of socioeconomic status (SES).

Introduction

FRAX® predicts 10-year fracture risk. Social factors may independently affect fracture risk. We investigated FRAX calibration and discrimination according to SES.

Methods

Women aged ≥50 years with baseline femoral neck bone mineral density (BMD) were identified from the Manitoba Bone Density Program, Canada (n?=?51,327), 1996–2011. Mean household income, extracted from 2006 census files, was categorized into quintiles. Ten-year fracture probabilities were calculated using FRAX Canada. Incident non-traumatic fractures were studied in relation to income quintile in adjusted Cox proportional hazards models. We compared observed versus predicted fractures with and without a competing mortality framework.

Results

During mean 6.2?±?3.7 years of follow up, there were 6,392 deaths, 3,723 women with ≥1 major osteoporotic fracture (MOF), and 1,027 with hip fractures. Lower income was associated with higher risk for death, MOF, and hip fracture in adjusted models (all p?<?0.005). More women in income quintile 1 (lowest) versus quintile 5 experienced death (19 vs. 8 %), MOF (10 vs. 6 %), or hip fracture (3.0 vs. 1.3 %) (all p?≤?0.001). Adjustment for competing mortality mitigated the effect of SES on FRAX calibration, and good calibration was observed. FRAX provided good fracture discrimination for MOF and hip fracture within each income quintile (all p?<?0.001). Area under the curve was slightly lower for income quintiles 1 versus 5 for FRAX with BMD to predict MOF (0.68, 95 % CI 0.66–0.70 vs. 0.71, 95 % CI 0.69–0.74) and hip fracture (0.79, 95 % CI 0.76–0.81 vs. 0.87, 95 % CI 0.84–0.89).

Conclusion

Increased fracture risk in individuals of lower income is offset by increased mortality. Under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of SES.     

Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly

Summary

In this prospective, 10-year study in community-dwelling elderly aged 50 years and over, hip fracture incidence and accordingly age at hip fracture were inversely associated with the area-level income, independently of the geographical area. Age at hip fracture also depended of marital status but in a gender-specific way.

Purpose

The purpose of this study is to investigate the impact of socioeconomic and living conditions on hip fracture incidence and age occurrence among community-dwelling elderly.

Method

Between January 1991 and December 2000, 2,454 hip fractures were recorded in community-dwelling adults aged 50 years and over in the Geneva University Hospital, State of Geneva, Switzerland. Median annual household income by postal code of residence (referred to as area-level income) based on the 1990 Census was used as a measure of socioeconomic condition and was stratified into tertiles (<53,170; 53,170–58,678; and ≥58,678 CHF). Hip fracture incidence and age occurrence were calculated according to area-level income categories and adjusted for confounding factors among community-dwelling elderly.

Results

Independently of the geographical area (urban versus rural), community-dwelling persons residing in areas with the medium income category presented a lower hip fracture incidence [OR 0.91 (0.82–0.99), p?=?0.049] compared to those from the lowest income category. Those in the highest income category had a hip fracture at a significant older age [+1.58 (0.55–2.61) year, p?=?0.003] as compared to those in the lowest income category. Age at hip fracture also depended on marital status but in a gender-specific way, with married women fracturing earlier.

Conclusions

These results indicate that incidence and age occurrence of hip fracture are influenced by area-level income and living conditions among community-dwelling elderly. Prevention programs may be encouraged in priority in communities with low income.     

Epidemiology of osteoporotic hip fractures in Western Romania

Purpose

Fragility hip fractures represent a major health and social burden. To date, there are no reports regarding mortality and factors that influence outcomes after osteoporotic hip fractures in Romania.

Material and methods

The electronic database of the largest healthcare provider in the western part of the country was searched for hip fracture admissions between 2008 and 2012. Inclusion criteria were age over 55 and the diagnosis of intra or extracapsular fractures, corresponding to ICD-10 S72.0 and S72.1 codes, respectively.

Results

A total of 1,866 patients met the criteria and were selected for data analysis. The gain in rates and crude numbers was caused mainly by a rise of fractures in males. The opposite is seen for the female-to-male ratio. Even though the mean age steadily increased for a total of 1.5 over a five-year period the patients are still younger than the European averages, which might explain the slightly better one-year survival. The age–gender adjusted hip fracture incidence increased dramatically with age, especially in women. The relative risk of dying in the first year is 1.359 times higher if the fracture is extracapsular (95 % CI 1.12–1.65). In total, 21.1 % of all patients die by one year after the fracture. This was drastically reduced for the following years. The survival function is significantly dependent on age group, level of fracture and time from hospital admission until surgery (p?Conclusions Increased age, extracapsular fractures and delayed surgery have worse outcomes. Regarding gender, even if not significant at the 0.05 level, probability of survival for females is higher for all time intervals. Updated, regional studies could be used in patient management to improve outcomes whilst decreasing costs.     

A decreasing trend in fall-related hip fracture incidence in Victoria, Australia

Summary

In Victoria, Australia, the age-standardised incidence of fall-related hip fracture hospitalisations decreased significantly by 25% over the period 1998/1999–2008/2009. Significant decreases in fall-related hip fractures were observed in males and females, across all 5-year age groups, in Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people.

Introduction

The study aim was to investigate trends in the incidence of fall-related and hip fracture hospitalisations among Victorians aged 65 years and older overall and by age, gender, country of birth, socio-economic status (SES) and location of the event (home, residential care institution, etc.) over the 11-year period 1998/1999 to 2008/2009.

Methods

Annual counts and age-standardised rates for fall-related hospitalisations among people aged 65 years and older were estimated using Victorian hospital admissions data. The statistical significance of changes in trends over time were analysed using a log-linear regression model of the rate data assuming a Poisson distribution of cases.

Results

Although the age-standardised incidence of fall-related hospitalisations increased significantly by 13% (95% confidence interval [CI], 9% to 18%) in Victoria, the age-standardised incidence of fall-related hip fracture hospitalisations decreased from 600/100,000 in 1998/1999 to 467/100,000 in 2008/2009 — an estimated overall reduction of 25% (95% CI, ?29% to ?22%). By contrast, the age-standardised incidence of fall-related hospitalisations for fractures at other body sites either increased significantly or showed no significant change. Significant decreases in fall-related hip fractures were observed in both males and females, across all 5-year age groups, in both Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people but not in people living in residential care facilities.

Conclusion

Despite the downward trend in the age-standardised incidence of fall-related hip fractures in Victoria, the burden of fall-related and hip fracture hospitalisations on health care systems and the community is set to escalate due to the ageing of the Victorian population.     

Quality of life in postoperative Japanese hip fracture patients: a hospital-based prospective study

Summary

This study aimed to study quality of life (QOL) in postoperative Japanese hip fracture patients. Although QOL in Japanese patients recovered to pre-fracture levels 1 year following hospitalization, the recovery varied and was associated with physical factors and living arrangements.

Introduction

The aim of this study was to investigate quality-of-life (QOL) changes in postoperative Japanese hip fracture patients.

Methods

Subjects were 113 hip fracture patients recruited and followed for 1 year following hospitalization. QOL was assessed using the Euro-QOL, which consists of the health status part (EQ-5D) and the visual analogue scale (EQ-VAS). Factors associated with change in QOL (calculated by subtracting pre-fracture score from the score at 1 year following hospitalization) were determined by multiple linear regression analysis.

Results

Of 81 patients who did not exhibit severe cognitive decline, 50 completed the follow-up surveys and were included for analysis. The mean difference from baseline was 0.035 (standard deviation = 0.254) for EQ-5D, and 17.0 (22.0) for EQ-VAS. Age, fracture type and residence status were significantly associated with a change in EQ-5D score. Cognitive function, activities of daily living and household help were significantly associated with a change in EQ-VAS score.

Conclusions

Contrary to previous studies from western countries, we found that QOL in Japanese patients recovered to pre-facture levels 1 year following hospitalization. This change varied between patients, and was associated with both physical factors and living arrangements.     

Who are the older Australians referred for a bone density scan? Data from the Barwon region

Summary

This study aimed to estimate the incidence rate of hip fracture during 2008–2010 in Shiraz, Iran. Overall, the standardized age-related incidence were 329.6/100,000 in men and 1,589.7/100,000 in women. The incidence rate in females was remarkably higher than the previous studies in Iran.

Purpose

This study aims to determine the incidence rate of hip fracture and its possible changes during 2008–2010 in Shiraz, Iran.

Materials and methods

This study reviewed and abstracted the hospital records, demographic, and clinical data of 1,923 patients aged 50 years or older with first time hip fracture admitted to private and public hospitals of Shiraz, Iran during 2008–2010 The age-adjusted incidence rate of hip fracture was determined along with association between gender, age, site of fracture, and socioeconomic status (SES) with the incidence rate.

Results

The mean age of subjects was 74.7 years (±10.6 years). Age-adjusted incidence rates for hip fracture, standardized to the 2000 US white male and female populations were 329.57 and 1,589.71 per 10⁵, respectively, while totally it was 461.1 per 10⁵. The incidence rate of hip fracture in females was higher than that of males in their 60s (1,229.2 versus 793.3), 70s (4,130.3 versus 2,835.3), and early 80s (4,506.8 versus 3,820.5) per 100,000. The hip fracture incidence in high SES area (157.1 per 100,000) followed by low SES regions (152.5 per 100,000) were higher compared to middle SES area (38.1 per 100,000) and towns around Shiraz (27.7 per 100,000) with fracture of the neck of femur being the most frequent affliction (391 per 100,000).

Conclusions

The rate of hip fracture is increasing in the area under study particularly in women and to a greater extent in those aged 60 years or older. Therefore, it is necessary to pay special attention to primary and secondary prevention of hip fracture.     

Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: The Japan Public Health Center-based Prospective Study

Summary

This study assessed the effects of physical activity on a 10-year incidence of self-reported vertebral fractures in adult women of a large Japanese cohort. Medium levels of strenuous activity and long-duration sedentary activity were associated with a lower incidence of vertebral fractures; association patterns appear to be different from hip fractures.

Introduction

Physical activity helps prevent hip fracture, but little is known about the longitudinal association between physical activity and vertebral fractures. The purpose of this study was to evaluate the effects of physical activity on the 10-year incidence of symptomatic vertebral fractures using data from the Japan Public Health Center-based Prospective Study.

Methods

Baseline studies were conducted in 1993–1994, and the follow-up study was conducted 10 years later. We analyzed 23,757 women aged 40–69 years. At baseline, physical activity was assessed as a predictor by using a questionnaire. Subjects were asked to report vertebral fractures that occurred during the 10-year follow-up period. Relative risks (RRs) adjusted for confounders were estimated by multiple logistic regression analysis.

Results

The 10-year cumulative incidence of vertebral fractures was 0.67 %. Those who engaged in strenuous physical activity of <1 h/day had a significantly lower incidence of vertebral fractures than those who did not engage in such activity (RR?=?0.52, 95 % CI 0.28–0.97), while those engaged in such activity ≥1 h/day did not (RR?=?0.82, 95 % CI 0.58–1.14). Long-duration sedentary activity was associated with a low incidence of vertebral fractures (P for trend?=?0.0002), but the frequencies of sports activities and metabolic equivalents were not (P for trend?=?0.0729 and 0.4341, respectively).

Conclusions

Strenuous activity and sedentary activity are associated with the incidence of vertebral fractures, although the association may not be linear. The pattern of association between physical activity and vertebral fractures appears to be different from that of hip fractures.     

Clinical and functional outcomes of internal fixation with intertrochanteric antegrade nail in older patients with proximal extracapsular femoral fractures

Purpose

The intertrochanteric Trigen Intertan^® nail (Smith & Nephew, Memphis, TN) is a popular fixation device for proximal extracapsular femoral fractures (PEFFs). We evaluated clinical and functional outcomes in patients with PEFFs treated with Trigen Intertan^® nail.

Methods

In a single-site, prospective observational study, clinical and functional parameters were recorded for all patients admitted to the Emergency Department with PEFFs from June 2008 through June 2011. Patients with severe cognitive impairment, severe disability, neoplastic pathological fractures, or suffering from terminal illnesses were not eligible for the study. Fractures were classified according to the AO/OTA classification system. Preoperative physical fitness was assessed via the American Association of Anaesthetists (ASA) score. The Barthel index was used to quantify the level of physical function before fracture and at follow-up.

Results

One-hundred thirty-five patients with PEFFs were eligible for inclusion during the 3-year survey (mean age 83.2 ± 9.5 years; 82 % females). Fracture type distribution was as follows: A1.1 = 18 %, A1.2 = 7 %, A1.3 = 5 %, A2.1 = 44 %, A2.2 = 21 %, A2.3 = 5 %. All patients were treated with Trigen Intertan^® nail. Two patients experienced a fracture of the femoral shaft during the insertion of a long nail for an A2.3 fracture. Weight-bearing was allowed between the third and tenth postoperative day depending on pain tolerance and general conditions. No loss of reduction, collapse of the femoral neck, nonunion or fixation failure were observed. Two patients died within 10 days postoperatively, and nine within 6 months after surgery. Functional status 1 month after surgery was lower than pre-fractural levels, and improved over follow-up. At 6 months, functional status was comparable to the pre-fractural level.

Conclusions

Trigen Intertan^® produces highly satisfactory clinical and functional results in older patients with PEFFs. Complete functional recovery is obtained on average 6 months after surgery.     

Impact of multidisciplinary hip fracture program on timing of surgery in elderly patients

Summary

The effect of patient characteristics and organizational and system factors on time to surgery were studied using Emilia Romagna Region database and hospital survey. The results showed that the implementation of a Hip Fracture Program significantly increased the probability of early surgery while single intervention had only slight effect

Introduction

The purpose of this study is to evaluate the effect of formal Hip Fracture Program (HFP) on timing of surgery in hip fracture older patients.

Methods

This is a retrospective cohort study based on Emilia Romagna administrative databases. Data on organizational and system factor were also obtained through a hospital survey. A multilevel logistic regression analysis was carried out to assess the effect of covariates on early surgery, taking into account patient level, hospital level, and trust level variability.

Results

From 1 January to 31 December 2011, 5,520 subjects over 65 years old underwent surgical repair for hip fracture in Emilia Romagna. The mean waiting time to surgery was 3.4?±?12.3 days, and the overall percentage of patients operated within 2 days was 52.2 %. In the adjusted multilevel logistic model, significant risk factors affecting the timing of surgical intervention at patient level were age, comorbidity, day of admission, and antiplatelet or warfarin therapy while no significant single variables were found at hospital level including dedicated operation theater, hospital volume, dedicated orthogeriatric beds, and geriatrician involvement. The most significant variable was the implementation of HFP at trust level that increased three times the probability of early surgery after adjusting for confounding variables (OR 3.216, 95 % CI 0.582–6.539).

Conclusions

Several modifiable organizational factors may affect the proportion of patients with hip fracture undergoing early surgery. This study suggests that the development and the implementation of an evidence-based HFP at trust level are a key point of the strategy of quality of care.     

Periprosthetic bone mineral density after total hip arthroplasty with an AMIStem or Quadra femoral component performed by a minimally invasive anterior approach (AMIS): a prospective randomized clinical dual-energy X-ray absorptiometry study

Introduction

This prospective 12 months of dual-energy X-ray absorptiometry (DEXA) study evaluated differences in periprosthetic bone mineral density in 40 patients undergoing cementless total hip arthroplasty (THA) by a minimally invasive anterior approach (AMIS), using Medacta AMIStem or Quadra stems. Both stems are straight rectangular. AMIStem shows reduced lateral flare and length in comparison to Quadra.

Objectives

The main goal of the study is to verify if bone mineral density is equivalent following THA with the AMIStem and Quadra femoral components.

Methods

Forty patients were randomly allocated to the Quadra and AMIStem groups. Three patients were lost to follow-up because they moved to another town, and revision surgery was performed on one patient due to periprosthetic fracture after a car accident. Patients were examined clinically and underwent DEXA preoperatively and at 1 week, 6 weeks, 6 months, and 1 year after THA. Patients enrolled had no preexisting lower limb arthroplasty and no osteoporosis.

Results

Harris hip score increased significantly for Quadra stem 5.3?±?14.1 and AMIStem 41.0?±?13.4. The high-activity hip score increased significantly for Quadra stem 3.8 ±2.2 and AMIStem 4.1?±?2.4. Considering 0.15 mg/cm² as an acceptable difference, bone mineral density for AMIStem and Quadra groups was statistically equivalent. A limited remodeling process with slight bone loss in the proximal calcar region R7, as expected after implantation of uncemented components, was observed for both stems.

Conclusions

The study demonstrates that the two stems are statistically equivalent in all zones at all time points investigated.     

Mobility and one-year mortality of stroke patients after hip-fracture surgery

Background

History of stroke is a risk factor for hip fracture. We investigated one-year mortality and change of mobility differences between stroke patients and non-stroke patients after hip-fracture surgery.

Methods

We retrospectively evaluated 548 patients who had hip-fracture surgery from May 2003 to Dec 2008 and were older than 50 years at the time of surgery. We identified 77 patients with a history of stroke and 471 patients with no history of stroke. We compared postoperative change of mobility and 1-year mortality for the two groups.

Results

Although stroke patients had lower preinjury mobility (p < 0.001) and higher American Society of Anesthesiologists score (p < 0.001), 1-year mortality and the decrease of mobility were similar to those for non-stroke patients.

Conclusions

History of stroke did not affect 1-year mortality and the decrease of mobility after hip fracture.

Level of evidence

Therapeutic level III.     

Functional outcome and mortality in nonagenarians following hip fracture surgery

Introduction

The world’s population is ageing and the elderly population itself is growing older. This population shows a high incidence of hip fractures. We performed a retrospective study, reviewing the functional status, postoperative complications and mortality rate of nonagenarians who underwent surgery for hip fracture.

Methods and subjects

56 nonagenarian patients underwent hip fracture surgery in our institution between January 2000 and December 2010. Two of these patients had presented with hip fracture on separate occasions, giving a total of 58 hips for analysis. Patients with open fracture, subtrochanteric fracture, polytrauma and pathological fracture were excluded. The case notes, electronic records and X-rays for all those included in the study were reviewed. The main outcome measures were functional status, postoperative complications and mortality rate at 1 year.

Results

Patients with extracapsular hip fractures were associated with higher risks of postoperative complications (60.7 %; p = 0.037), mortality (25 %; p = 0.003) and more likely to be non-ambulant at 1 year (53.6 vs 16.7 %; p = 0.003). Females were more likely to suffer postoperative complications than males (p = 0.016). 46.6 % of the patients had immediate postoperative complications and most commonly due to urological complications (29.3 %). The 1-year mortality rate was 12.1 %. A notable proportion of patients (65.5 %) remained ambulant 1 year postoperatively, although almost half of the patients (48.3 %) who could ambulate independently pre-injury required a walking aid after hip fracture surgery.

Conclusion

Nonagenarians have good surgical outcomes after hip fracture surgery with low mortality rate. They should be treated similarly as their younger counterparts in terms of decision for surgery. Potential decline in functional status and rehabilitation options should be shared with the patient and family at an early stage.