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; FAITH Trial Investigators

doi:10.1097/BOT.0000000000000123

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

J Orthop Trauma. 2014 Dec;28(12):e273-80. doi: 10.1097/BOT.0000000000000123.

Authors

Stephanie M Zielinski¹, Noël L Keijsers, Stephan F E Praet, Martin J Heetveld, Mohit Bhandari, Jean Pierre Wilssens, Peter Patka, Esther M M Van Lieshout; FAITH Trial Investigators

Collaborators

FAITH Trial Investigators:
Mohit Bhandari, Marc Swiontkowski, Philip J Devereaux, Gordon Guyatt, Martin J Heetveld, Kyle Jeray, Susan Liew, Emil H Schemitsch, Lehana Thabane, Stephen Walter, Mohit Bhandari, Sheila Sprague, Taryn Scott, Marilyn Swinton, Helena Viveiros, Diane Heels-Ansdell, Qi Zhou, Lisa Buckingham, Aravin Duraikannan, Deborah Maddock, Marc Swiontkowski, Julie Agel, Martin J Heetveld, Esther M M Van Lieshout, Stephanie M Zielinski, Amar Rangan, Birgit Hanusch, Gregory J Della Rocca, Robert Haverlag, Susan Liew, Gerard Slobogean, Jeffrey Katz, Brenda Gillespie, Gail A Greendale, Pierre Guy, Curtis Hartman, Craig Rubin, James Waddell, Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Trevor Stone, Darius Viskontas, H Michael Lemke, Mauri Zomar, Karyn Moon, Raely Moon, Amber Oatt, Richard E Buckley, Paul Duffy, Robert Korley, Shannon Puloski, Kelly Johnston, James Powell, Kimberly Carcary, David Sanders, Abdel Lawendy, Christina Tiezer, David Stephen, Hans Kreder, Richard Jenkinson, Markku Nousiainene, Terry Axelrod, John Murnaghan, Diane Nam, Robin Richards, Sebastian Rodriguez-Elizalde, Veronica Wadey, Albert Yee, Katrine Milner, Monica Kunz, Melanie MacNevin, Ria Cagaanan, Ryan Bicknell, Jeff Yach, Davide Bardana, Gavin Wood, Mark Harrison, David Yen, Sue Lambert, Fiona Howells, Angela Ward, Chad Coles, Ross Leighton, Michael Biddulph, David Johnston, Mark Glazebrook, David Alexander, Cathy Coady, Michael Dunbar, Kelly Trask, Shelley MacDonald, Gwen Dobbin, Emil H Schemitsch, Henry Ahn, Jeremy A Hall, Michael D McKee, Daniel B Whelan, Aaron Nauth, Milena Vicente, Lisa Wild, Ryan Khan, Jennifer Hidy, Paul Zalzal, Heather Brien, V Naumetz, Brad Weening, Nicole Simunovic, Eugene K Wai, Steve Papp, Wade T Gofton, Allen Liew, Stephen P Kingwell, Darren M Roffey, Vivian Borsella, Victoria Avram, Todd M Oliver, Vicki Jones, Clifford Jones, James Ringler, Terrence Endres, Debra L Sietsema, Kyle J Jeray, J Scott Broderick, David R Goetz, Thomas B Pace, Thomas M Schaller, Scott E Porter, Stephanie L Tanner, Rebecca G Snider, Lauren A Nastoff, Shea A Bielby, Andrew J Marcantonio, Richard Iorio, John Garfi, Michael J Prayson, Richard Laughlin, Joseph Rubino, Jedediah May, Geoffrey Ryan Rieser, Liz Dulaney-Cripe, Chris Gayton, Julie A Switzer, Peter A Cole, Sarah A Anderson, Paul M Lafferty, Mengnai Li, Thuan V Ly, Scott B Marston, Amy L Foley, Sandy Vang, David M Wright, Heather A Vallier, Andrea Dolenc, Chalitha Robinson, John T Gorczyca, Jonathan M Gross, Catherine A Humphrey, Stephen Kates, Krista Noble, Allison W McIntyre, Kaili Pecorella, James Shaer, Tyson Schrickel, Barbara Hileman, Craig A Davis, Stewart Weinerman, Peter Weingarten, Philip Stull, Stephen Lindenbaum, Michael Hewitt, John Schwappach, Janell K Baker, Samir Mehta, John Esterhai, Jaimo Ahn, Annamarie D Horan, Kelly McGinnis, Christine A Kaminiski, Brynn N Kowalski, Lisa K Cannada, David Karges, Leslie Hill, Ivan Tarkin, Peter Siska, Gary Gruen, Andrew Evans, Dana J Farrell, James Irrgang, Arlene Luther, Jonathan P Keeve, Christopher G Anderson, Michael D McDonald, Jodi M Hoffman, Mark Jenkins, Jules Dumais, Amanda W Romero, Joseph R Hsu, James Ficke, Michael Charlton, Matthew Napierala, Mary Fan, William W Cross 3rd, Joseph R Cass, Stephen A Sems, Michael E Torchia, Tyson Scrabeck, Carlos A Sagebien, Mark S Butler, James T Monica, Patricia Seuffert, Michael L Brennan, Robert Probe, Evelyn Kile, Kelli Mills, Lydia Clipper, Michelle Yu, Katie Erwin, Paul Tornetta 3rd, Hope Carlisle, Heather Silva, Michael Archdeacon, Ryan Finnan, Toan Le, John Wyrick, Shelley Hess, Jessica McBeth, Kamran Aurang, Gary Zohman, Brett Peterson, Roger B Huff, Joseph Baele, Timothy Weber, Matt Edison, Andrew H Schmidt, Jerald R Westberg, Charles J DePaolo, Rachel Alosky, Leslie E Shell, Lynne Hampton, Stephanie Shepard, Tracy Nanney, Claudine Cuento, Karl Shively, Janos P Ertl, Brian Mullis, J Andrew Parr, Ripley Worman, Valda Frizzell, Molly M Moore, Erin Tobias, Emily Thomas, Robert V Cantu, Eric R Henderson, Linda S Eickhoff, David P Zamorano, Deeba Pourmand, Deanna Lawson, E Mark Hammerberg, Philip Stahel, David Hak, Cyril Mauffrey, Douglas Gibula, Hannah Gissel, Corey Henderson, Gregory J Della Rocca, Brett D Crist, Yvonne M Murtha, Melinda McPherson, Linda K Anderson, Michael P Dohm, Colleen Linehan, Lindsey Pilling, Daniel Horwitz, Kent Strohecker, Courtland G Lewis, Stephanie Caminiti, Raymond J Sullivan, Elizabeth Roper, William Obremsky, Philip Kregor, Justin E Richards, Kenya Stringfellow, J Carel Goslings, Robert Haverlag, Jan Ponsen, Maarten W G A Bronkhorst, Onno R Guicherit, Peter Patka, Martin G Eversdijk, Rolf Peters, Dennis Den Hartog, Oscar J F Van Waes, Pim Oprel, Piet A R de Rijcke, Cees L Koppert, Steven E Buijk, Richard P R Groenendijk, Imro Dawson, Geert W M Tetteroo, Milko M M Bruijninckx, Pascal G Doornebosch, Eelco J R de Graaf, Martin J Heetveld, Gijs A Visser, Heyn Stockman, Rob Silvis, Jaap P Snellen, Bram Rijbroek, Joris J G Scheepers, Erik G J Vermeulen, Michel P C Siroen, Ronald Vuylsteke, Hans L F Brom, Herman Rijna, Gert R Roukema, Hong Josaputra, Paul Keller, Peter D de Rooij, Hans Kuiken, Han Boxma, Berry I Clefken, Ronald Liem, Steven J Rhemrev, Coks H R Bosman, Alexander de Mol van Otterloo, Jochem Hoogendoorn, Alexander C de Vries, Sven A G Meylaerts, Rudolf W Poolman, Maarten P Simons, Frank H W M van der Heijden, W Jaap Willems, Frank R A J de Meulemeester, Cor P van der hart, Kahn Turckan, Sebastiaan Festen, Frank de Nies, Robert Haverlag, Nico J M Out, Jan Bosma, Maarten van der Elst, Carmen C van der Pol, Martijne van't Riet, Tom M Karsten, Mark de Vries, Laurents P S Stassen, Niels W L Schep, G Ben Schmidt, W H Hoffman, Michiel J M Segers, Jacco A C Zijl, Bart Verhoeven, Anke B Smits, Jean Paul P M de Vries, Bram Fioole, Henk van der Hoeven, Evert B M Theunissen, Tammo S de Vries Reilingh, Lonneke Govaert, Philippe Wittich, Maurits de Brauw, Jan Wille, Peter M N Y M Go, Ewan D Ritchie, Ronald N Wessel, Eric R Hammacher, Michiel H J Verhofstad, Joost Meijer, Teun van Egmond, Frank H W M van der Heijden, Igor van der Brand, Harm van der Vis, Martin Campo, Ronald Verhagen, Albert Robert Albers, Arthur W Zurcher, Albert von Kampen, Jan Biert, Arie B van Vugt, Michael J R Edwards, Taco J Blokhuis, Jan Paul M Frölke, Leo M G Geeraedts, Jean W M Gardeniers, Edward T C H Tan, Lodewijk M S J Poelhekke, Maarten C de Waal Malefijt, Bart Schreurs, Rogier K J Simmermacher, Jeroen van Mulken, Karlijn van Wessem, Taco J Blokhuis, Steven M van Gaalen, Luke P H Leenen, Susan Liew, Harvinder Bedi, Ashley Carr, Andrew Chia, Steven Csongvay, Hamish Curry, Stephen Doig, Craig Donohue, Elton Edwards, Greg Etherington, Andrew Gong, Arvind Jain, Doug Li, Russell Miller, Ash Moaveni, Matthias Russ, Lu Ton, Otis Wang, Zoe Murdoch, Claire Sage, Frede Frihagen, John Clarke-Jenssen, Geir Hjorthaug, Torben Ianssen, Asgeir Amundsen, Jan Egil Brattgjerd, Tor Borch, Berthe Bøe, Bernhard Flatøy, Sondre Hasselund, Knut Jørgen Haug, Kim Hemlock, Tor Magne Hoseth, Geir Jomaas, Thomas Kibsgård, Bjorn Kristiansen, Tarjei Lona, Gilbert Moatshe, Oliver Müller, Marius Molund, Tor Nicolaisen, Fredrik Nilsen, Jonas Rydinge, Morten Smedsrud, Are Stødle, Axel Trommer, Stein Ugland, Elise Berg Vesterhus, Anne Christine Brekke, Ateet Sharma, Amir Sanghavi, Kevin Tetsworth, Donald Geoff, Patrick Weinrach, Steven Yang, Brett Halliday, Trevor Gervais, Michael Holt, Annette Flynn, Amal Shankar Prasad, Vimlesh Mishra, Ajay Gupta, Niraj Jain, Mahesh Bahatia, Vinod Arora, Mahesh Bhatia, D C Sundaresh, Angshuman Khanna, Anil Rai, Marinis Pirpiris, David Love, Andrew Bucknill, Richard J Farrugia, Akhil Dadi, Naveen Palla, B Sachidananda Rai, Janakiraman Rajakumar, Joe Joseph Cherian, Davy J Olakkengil, Gaurav Sharma

Affiliation

¹ Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; †Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen, the Netherlands; ‡Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; §Department of Surgery, Kennemer Gasthuis, Haarlem, the Netherlands; ‖Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; ¶RSscan International, Olen, Belgium; and **Department of Accident and Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

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.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Cohort Studies
Femoral Neck Fractures / physiopathology
Femoral Neck Fractures / surgery*
Fracture Fixation, Internal / adverse effects
Gait
Humans
Leg Length Inequality
Middle Aged
Muscle Strength
Quality of Life
Recovery of Function
Reoperation
Salvage Therapy
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding