Austin Moore hemiprosthesis for intracapsular hip fracture: analysis of mortality, infection and dislocation in 91 patients.
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Published:
Oct 6, 2014
Keywords:
Hemiarthroplasty. Intracapsular fracture. Mortality. Dislocation. Infection.
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Abstract
AbstractBackground: Hip fractures are common in elderly people. Hemiarthroplasty is an accepted treatment for intracapsular fractures of the hip in elderly patients with low functional demands. The objective of this study is to show the 30-day and 1-year mortality rates and associated complications in patients with bad performance status.Methods: Between 2003 and 2010, 1,134 patients with intracapsular fractures of the hip were treated. One hundred and one patients (9%) were treated with Austin Moore hemiprosthesis and 91 of them were included in this series. All were toddlers in their homes and they had multiple comorbidities. Kaplan-Meier estimator was used to evaluate survival. Mortality was then related to sex, age, infection and dislocation using a Cox proportional hazards regression model.Results: Seventy patients were women (77%) and the mean age of the series was 85 years. The 30-day and 1-year mortality rates were 7% and 36%, respectively. Ten patients (11%) had an episode of prosthetic dislocation and 13 (14.3%) had an infectious complication. Infection/mortality and male/mortality associations were statistically significant (p = 0.009 and p = 0.013). Patients who suffered an infection had a higher rate of dislocation (p = 0.00001).Conclusion: Hemiarthroplasty with Austin Moore prosthesis is a good option for patients with displaced intracapsular hip fractures, low activity demand and multiple comorbidities, since it is a quick procedure that eliminates pain, allowing early mobility.
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Albergo, J. I., Buttaro, M., Ochoa, G. A., Comba, F., Zanotti, G., & Piccaluga, F. (2014). Austin Moore hemiprosthesis for intracapsular hip fracture: analysis of mortality, infection and dislocation in 91 patients. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(3), 149-153. https://doi.org/10.15417/205
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Clinical Research
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References
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2. Morris AH, Zuckerman JD. National consensus conference on improving the continuum of care for patients with hip fracture.
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hemiarthroplasty, and total hip arthroplasty: Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone
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institution. HSS J 2012;8(2):111-5.
7. Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus
cemented and noncemented hemiarthroplasty. J Arthroplasty 1986;1:21-8.
8. Pitto RP, Koessler M. The risk of fat embolism during cemented total hip replacement in the elderly patient. Chir Organi Mov
1999;84:119-28.
9. Oakes DA, Jackson KR, Davies MR, Ehrhart KM, Zohman GL, Koval KJ, Lieberman JR. The impact of the Garden
classification on proposed operative treatment. Clin Orthop Relat Res 2003;409:232-40.
10. Dickson JA. The unsolved fracture. J Bone Joint Surg Am 1953;35(4):805.
11. Abboud JA, Patel RV, Booth RE Jr, Nazarian DG. Outcomes of total hip arthroplasty are similar for patients with displaced
femoral neck fractures and osteoarthritis. Clin Orthop Relat Res 2004;421:151-4.
12. Delamarter R, Moreland JR. Treatment of acute femoral neck fractures with total hip arthroplasty. Clin Orthop Relat Res
1987;218:68-74.
13. Taine WH, Armour PC. Primary total hip replacement for displaced subcapital fractures of the femur. J Bone Joint Surg Br
1985;67:214-7.
14. Fraser T, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: A randomized clinical trial. J Bone Joint
Surg Am 2012;94:577-83.
15. Kwok DC, Cruess RL. A retrospctive study of Moore and Thompson hemiarthroplasty-a review of 599 surgical cases and an
analysis of the technical complications. Clin Orthop Relat Res 1982;169:179-85.
16. Warwick D, Hubble M, Sarris I, Strange J. Revision of failed hemiarthroplasty for fractures at the hip. Int Orthop
1998;22:165-8.
17. Macaulay W, Pagnotto M, Iorio R, Mont M, Saleh K. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus
total hip arthroplasty. J Bone Joint Surg Am 2006;14(5):287-93.
18. Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital
fractures of femur—13 year results of a prospective randomized study. Injury 2000;31:793-7.
19. Rodriguez-Merchan EC. Displaced intracapsular hip fractures: Hemiarthroplasty or total arthroplasty? Clin Orthop Relat Res
2002;399:72-7.
20. Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomized trial of internal fixation versus arthroplasty for displaced
fractures of the neck of the femur: Functional outcomes for 450 patients at two years. J Bone Joint Surg Br 2002;84:183-8.
21. Lee BP, Berry DJ, Harmsen WS, Sim FH. Total hip arthroplasty for the treatment of an acute fracture of the femoral neck:
long-term results. J Bone Joint Surg Am 1998;80:70-5.
22. Kofoed H, Kofod J. Moore prosthesis in the treatment of fresh femoral neck fractures: A critical review with special attention to
secondary acetabular degeneration. Injury 1983;14:531-40.
23. Phillips TW. Thompson hemiarthroplasty and acetabular erosion. J Bone Joint Surg Am 1989;71:913-9.
24. Parvizi J. Cardiac output during hemiarthroplasty of the hip. J Bone Joint Surg Br 2003;85:149.
25. Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement.
Findings in patients who have insertion of a femoral component with and without cement. J Bone Joint Surg Am 1993;75:581-7.
26. Singh G, Deshmukh R. Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture
neck of femur-Comparison of complications and patient satisfaction. Injury 2006;37:169-74.
27. Emery RJH, Broughton NS, Desai K, Bulstrode CJK, Thomas TL. Bipolar hemiarthroplasty for subcapital fracture of the
femoral neck. J Bone Joint Surg Br 1991;73(2):322-4.
28. Lo W-H, Chen W-M, Huang C-K, Chen T-H, Chiu F-Y, Chen C-M. Bateman bipolar hemiathroplasty for displaced
intracapsular femoral neck fractures. Clin Orthop Relat Res 1994;302:75-82
2. Morris AH, Zuckerman JD. National consensus conference on improving the continuum of care for patients with hip fracture.
J Bone Joint Surg Am 2002;84:670-4.
3. Ray NF, Chan JK, Thamer M, Melton LJ III. Medical expenditures for the treatment of osteoporotic fractures in the United
States in 1995: Report from the National Osteoporosis Foundation. J Bone Miner Res 1997;12:24-35.
4. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar
hemiarthroplasty, and total hip arthroplasty: Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone
Joint Surg Am 2006;88:249-60.
5. Shah AK, Eissler J, Radomisli T. Algorithms for the treatment of femoral neck fractures. Clin Orthop Relat Res 2002;399:28-
34.
6. Comba F, Alonso Hidalgo I, Buttaro M, Piccaluga F. Risk factor analysis for 30-day mortality after primary THA in a single
institution. HSS J 2012;8(2):111-5.
7. Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus
cemented and noncemented hemiarthroplasty. J Arthroplasty 1986;1:21-8.
8. Pitto RP, Koessler M. The risk of fat embolism during cemented total hip replacement in the elderly patient. Chir Organi Mov
1999;84:119-28.
9. Oakes DA, Jackson KR, Davies MR, Ehrhart KM, Zohman GL, Koval KJ, Lieberman JR. The impact of the Garden
classification on proposed operative treatment. Clin Orthop Relat Res 2003;409:232-40.
10. Dickson JA. The unsolved fracture. J Bone Joint Surg Am 1953;35(4):805.
11. Abboud JA, Patel RV, Booth RE Jr, Nazarian DG. Outcomes of total hip arthroplasty are similar for patients with displaced
femoral neck fractures and osteoarthritis. Clin Orthop Relat Res 2004;421:151-4.
12. Delamarter R, Moreland JR. Treatment of acute femoral neck fractures with total hip arthroplasty. Clin Orthop Relat Res
1987;218:68-74.
13. Taine WH, Armour PC. Primary total hip replacement for displaced subcapital fractures of the femur. J Bone Joint Surg Br
1985;67:214-7.
14. Fraser T, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: A randomized clinical trial. J Bone Joint
Surg Am 2012;94:577-83.
15. Kwok DC, Cruess RL. A retrospctive study of Moore and Thompson hemiarthroplasty-a review of 599 surgical cases and an
analysis of the technical complications. Clin Orthop Relat Res 1982;169:179-85.
16. Warwick D, Hubble M, Sarris I, Strange J. Revision of failed hemiarthroplasty for fractures at the hip. Int Orthop
1998;22:165-8.
17. Macaulay W, Pagnotto M, Iorio R, Mont M, Saleh K. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus
total hip arthroplasty. J Bone Joint Surg Am 2006;14(5):287-93.
18. Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital
fractures of femur—13 year results of a prospective randomized study. Injury 2000;31:793-7.
19. Rodriguez-Merchan EC. Displaced intracapsular hip fractures: Hemiarthroplasty or total arthroplasty? Clin Orthop Relat Res
2002;399:72-7.
20. Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomized trial of internal fixation versus arthroplasty for displaced
fractures of the neck of the femur: Functional outcomes for 450 patients at two years. J Bone Joint Surg Br 2002;84:183-8.
21. Lee BP, Berry DJ, Harmsen WS, Sim FH. Total hip arthroplasty for the treatment of an acute fracture of the femoral neck:
long-term results. J Bone Joint Surg Am 1998;80:70-5.
22. Kofoed H, Kofod J. Moore prosthesis in the treatment of fresh femoral neck fractures: A critical review with special attention to
secondary acetabular degeneration. Injury 1983;14:531-40.
23. Phillips TW. Thompson hemiarthroplasty and acetabular erosion. J Bone Joint Surg Am 1989;71:913-9.
24. Parvizi J. Cardiac output during hemiarthroplasty of the hip. J Bone Joint Surg Br 2003;85:149.
25. Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement.
Findings in patients who have insertion of a femoral component with and without cement. J Bone Joint Surg Am 1993;75:581-7.
26. Singh G, Deshmukh R. Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture
neck of femur-Comparison of complications and patient satisfaction. Injury 2006;37:169-74.
27. Emery RJH, Broughton NS, Desai K, Bulstrode CJK, Thomas TL. Bipolar hemiarthroplasty for subcapital fracture of the
femoral neck. J Bone Joint Surg Br 1991;73(2):322-4.
28. Lo W-H, Chen W-M, Huang C-K, Chen T-H, Chiu F-Y, Chen C-M. Bateman bipolar hemiathroplasty for displaced
intracapsular femoral neck fractures. Clin Orthop Relat Res 1994;302:75-82