Intracapsular femoral neck fractures in the geriatric population are usually treated with hemiarthroplasty or total hip arthroplasty. The patients’ medium-term to long-term mortality is a consideration to help decide which procedure to perform. The aim of this study is to examine whether easily identifiable serum investigations and patient identifiable factors on admission are associated with medium-term and long-term mortality.
A consecutive series of 331 patients who sustained intracapsular femoral neck fractures and were over the age of 55 years were identified and retrospectively reviewed. American Society of Anesthesiologists (ASA) grade, cognitive function, gender, age, mobility status, and admission serum investigations were considered.
Low albumin levels, advanced age, men, and a combination of high ASA with lower mobility status were independent predictors of mean 5-year mortality. Similarly, low albumin levels and a combination of high ASA with lower mobility status were found to be independent predictors of longer term mortality (7-9 years). The optimal albumin cut-off to identify patient survival was >42 g/L with an area under the curve of 0.71.
We suggest that serum albumin on admission can be utilized as a factor to identify patients who are likely to survive at up to 9-year mean follow-up, to guide decision for total hip arthroplasty over hemiarthroplasty.
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- The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data.Med Care. 2015; 53: 686
- Total hip arthroplasty versus hemiarthroplasty for independently mobile older adults with intracapsular hip fractures.BMC Musculoskelet Disord. 2019; 20: 226
- Nationwide analysis of femoral neck fractures in elderly patients: a receding tide.J Bone Joint Surg Am. 2017; 99: 1932-1940
- A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur: functional outcome for 450 patients at two years.J Bone Joint Surg Br. 2002; 84: 183-188
- The management of hip fracture in adults.[accessed 05.01.21])
- Inequalities in use of total hip arthroplasty for hip fracture: population based study.BMJ. 2016; 353: i2021
- Time to put aside the controversy between total hip arthroplasty and hemiarthroplasty: commentary on an article by bheeshmaravi, md, phd, et al.:“comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures. A propensity score-matched, population-based study”.J Bone Joint Surg Am. 2019; 101: e29
- Total hip arthroplasty or hemiarthroplasty for hip fracture.N Engl J Med. 2019; 381: 2199-2208
- Predictors of 5 year survival following hip fracture.Injury. 2011; 42: 1253-1256
- Pre-operative nutritional serum parameters as predictors of failure after internal fixation in undisplacedintracapsular proximal femur fractures.Injury. 2015; 46: 1571-1576
- Preoperative hypoalbuminemia: poor functional outcomes and quality of life after hip fracture surgery.Bone. 2020; 143: 115567
- Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture.J Bone Joint Surg Am. 2017; 99: 2110-2118
- Hypoalbuminaemia—a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures.Injury. 2017; 48: 436-440
- Low-angle fixation in fractures of the femoral neck.J Bone Joint Surg Br. 1961; 43: 647-663
- Mortality after hip fracture in Japan: the role of nutritional status.J Orthopaedic Surg. 2010; 18: 265-270
- Haematological indices as surrogate markers of factors affecting mortality after hip fracture.Injury. 2011; 42: 178-182
No authors listed. National Hip Fracture Database (NHFD) annual report 2013.
- New classification of physical status.Anesthesiology. 1963; 24: 111
- Management of hip fracture.Br Med Bull. 2015; 115: 165-172
- The abbreviated mental test: its use and validity.Age and ageing. 1991; 20: 332-336
- Receiver operating characteristic (ROC) methodology: the state of the art.Crit Rev Diagn Imaging. 1989; 29: 307-335
- Biostatistics series module 9: survival analysis.Indian J Dermatol. 2017; 62: 251
- Hypoalbuminemia is an independent risk factor for 30-day mortality, postoperative complications, readmission, and reoperation in the operative lower extremity orthopaedic trauma patient.J Orthopaedic Trauma. 2019; 33: 284-291
- Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur.Ann R Coll Surgeons Engl. 2013; 95: 26-28
- Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials.Int Orthopaedics. 2012; 36: 1549-1560
- Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial.J Bone Joint Surg Am. 2011; 93: 445-450
- Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty.Health Technol Assess. 2005; 9: 1-65
- Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture.HSS J. 2008; 4: 48-54
- Hemiarthroplasty or total hip arthroplasty for the treatment of a displaced intracapsular fracture in active elderly patients: 12-year follow-up of randomised trial.Bone Joint J. 2017; 99: 250-254
- Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty.J Arthroplasty. 1986; 1: 21-28
- Failure of hemiarthroplasty for fractures of the neck of the femur.Injury. 1984; 15: 224-226
- The natural history of the hemiarthroplasty for displaced intracapsular femoral neck fractures: 302 patients followed until revision or death.Actaorthopaedica. 2013; 84: 555-560
- The cartilage degeneration and joint motion of bipolar hemiarthroplasty.Int Orthopaedics. 2012; 36: 2015-2020
- Treatment of the displaced intracapsular fracture for the ‘fitter’elderly patients: a randomised trial of total hip arthroplasty versus hemiarthroplasty for 105 patients.Injury. 2019; 50: 2009-2013
- The effect of hospital type and surgical delay on mortality after surgery for hip fracture.J Bone Joint Surg Br. 2005; 87: 361-366
- Revision risk after unipolar or bipolar hemiarthroplasty for femoral neck fractures: an instrumental variable analysis of 62,875 procedures from the Australian orthopaedic association national joint replacement registry.J Bone Joint Surg Am. 2021; 103: 195-204
- Nutritional supplementation for hip fracture aftercare in older people.Cochrane Database Syst Rev. 2016; 11: CD001880
- Low predictive power of comorbidity indices identified for mortality after acute arthroplasty surgery undertaken for femoral neck fracture.Bone Joint J. 2019; 101: 104-112
Published online: August 11, 2022
Accepted: August 7, 2022
Received in revised form: August 2, 2022
Received: March 9, 2022
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.08.015.
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