Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation

Tzu-Chieh Lin; Pin-Wen Wang; Chun-Teng Lin; Yu-Jun Chang; Ying-Ju Lin; Wen-Miin Liang; Jeff Chien-Fu Lin

doi:10.1186/s12891-021-04277-7

Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation

BMC Musculoskelet Disord. 2021 Apr 30;22(1):403. doi: 10.1186/s12891-021-04277-7.

Authors

Tzu-Chieh Lin^{1

2}, Pin-Wen Wang¹, Chun-Teng Lin³, Yu-Jun Chang⁴, Ying-Ju Lin^{5

6}, Wen-Miin Liang⁷, Jeff Chien-Fu Lin^{8

9}

Affiliations

¹ Department of Public Health, China Medical University, Taichung, Taiwan.
² Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan.
⁴ Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan.
⁵ Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
⁶ School of Chinese Medicine, China Medical University, Taichung, Taiwan.
⁷ Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan. wmliang@mail.cmu.edu.tw.
⁸ Department of Statistics, National Taipei University, No.67, Sec. 3, Ming-Shen E. Rd, Taipei, 10478, Taipei, Taiwan. cflin.ntpu@gmail.com.
⁹ Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. cflin.ntpu@gmail.com.

Abstract

Background: Most unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation.

Methods: We studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation.

Results: The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death.

Conclusions: The mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population.

Keywords: Hemiarthroplasty; Mortality; Readmission; Reoperation; Unstable trochanteric fracture.

MeSH terms

Aged
Female
Fracture Fixation, Internal
Hemiarthroplasty* / adverse effects
Hip Fractures* / diagnostic imaging
Hip Fractures* / surgery
Humans
Male
Middle Aged
Patient Readmission
Reoperation
Retrospective Studies
Treatment Outcome