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Hemiarthroplasty versus total hip arthroplasty for femoral neck fractures in patients with chronic obstructive pulmonary disease

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study sought to delineate whether total hip arthroplasty (THA) or hip hemiarthroplasty (HHA) had more complication rates following the treatment of femoral neck fractures (FNF) in chronic obstructive pulmonary disease (COPD) patients.

Materials and methods

The ACS-NSQIP database was queried for all patients with a history of COPD who had undergone THA and HHA with FNFs, isolated by CPT codes and ICD-9/ICD-10 codes. Propensity score matching without replacement in a 1:1 manner was done to control for patient demographics/preoperative comorbidities. Multivariate logistic regression models were utilized to assess the independent effect of HHA in comparison to THA.

Results

The propensity-matched (PM) HHA cohort was significantly older (76.14 years vs. 73.33 years, p = 0.001) and had significantly higher rates of pneumonia (p = 0.017), extended length of stay (LOS) (p = 0.017), and mortality (p = 0.002), but lower rates of blood transfusions (p = 0.016) and reoperation (p = 0.020). HHA was independently associated with an increased risk of pneumonia (p = 0.043), extended LOS (p = 0.050), and death (p = 0.044) but a decreased risk for blood transfusions (p = 0.008) and reoperation (p = 0.028) when compared to THA.

Discussion

Patients with more comorbidities are more likely to receive HHA than THA, which may explain some of the increased complications and mortality associated with HHA for FNFs compared to THA. Patients undergoing THA were at increased risk for blood transfusion and reoperation. THA does not appear to result in increased morbidity in this population compared to HHA. While THA should be considered in these patients given improved functional outcomes, further prospective studies are needed to establish superiority.

Level of evidence

III.

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Funding

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Authors and Affiliations

  1. The George Washington University School of Medicine and Health Sciences, The George Washington University, 2300 I St NW, Washington, DC, 20037, USA

    Danny Lee, Ryan Lee & Nidhi Shah

  2. Department of Orthopaedic Surgery, The George Washington University, 2300 M St NW, Washington, DC, 20037, USA

    Andrew Tran, Jessica H. Heyer, Alice J. Hughes & Rajeev Pandarinath

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  1. Danny Lee
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  2. Ryan Lee
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  4. Nidhi Shah
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Corresponding authors

Correspondence to Danny Lee or Rajeev Pandarinath.

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The authors declare no conflict of interest.

Ethical approval

No IRB approval was required as this study utilized the ACS-NSQIP Database—a nationwide publicly available database with de-identified patient information. Therefore, no informed consent was required.

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Lee, D., Lee, R., Tran, A. et al. Hemiarthroplasty versus total hip arthroplasty for femoral neck fractures in patients with chronic obstructive pulmonary disease. Eur J Trauma Emerg Surg 47, 547–555 (2021). https://doi.org/10.1007/s00068-019-01234-x

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  • DOI: https://doi.org/10.1007/s00068-019-01234-x

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