Survivorship of Total Hip Arthroplasty After Acute Hip Fracture and Failed Osteosynthesis Based on the Finnish Arthroplasty Register With a 4-Year Mean Follow-Up.

Abstract

Surgical treatment options for femoral neck fracture (FNF) include arthroplasty and internal fixation (IF). An IF is associated with faster operation time, less blood loss, and fewer hospitalization days compared to arthroplasty. However, reoperation rates are significantly higher compared to treatment with total hip arthroplasty (fracture-THA). Most reoperations following IF include implant removal surgeries and conversions to THA (salvage-THA). We assessed survivorship of 3,823 fracture-THA, 298 salvage-THA, and 73,141 THA performed for osteoarthritis (OA-THA) based on the Finnish Arthroplasty Register (FAR) using a Kaplan-Meier estimator. In addition, we conducted Cox regression analyses to assess risk factors for a revision operation after fracture-THA. Inferior Kaplan-Meier 7-year survivorship was observed in the fracture-THA (91.5%, 95% confidence interval (CI) [90.4 to 92.7]) and salvage-THA (89.4%, 95% CI [84.8 to 94.1]) groups compared to the OA-THA group (95.4%, 95% CI [95.2 to 95.5]). Survivorship between the fracture-THA group and the salvage-THA group was comparable. In the multivariate Cox regression analyses for risk factors for revision due to infection, dislocation, or periprosthetic fracture, no statistically significant factors were identified. We conclude that the 7-year survivorship of fracture-THA and salvage-THA is similar, but inferior compared to that of OA-THA.