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20.06.2018 | Original Paper

Osteoarthritis is associated with increased failure of proximal femoral fracture fixation

verfasst von: Charles A. Gallagher, Christopher W. Jones, Lara Kimmel, Christopher Wylde, Anthony Osbrough, Max Bulsara, Kathryn Hird, Piers Yates

Erschienen in: International Orthopaedics | Ausgabe 5/2019

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Abstract

Purpose

The purpose of this study was to evaluate whether the presence of hip osteoarthritis at the time of hip fracture increases treatment failure rates when using either a sliding hip screw (SHS) or proximal femoral nail (PFN) for fracture fixation.

Methods

A retrospective study of a consecutive series of 455 women and 148 men (median age, 83.8 years) treated with SHS or PFN was performed. Osteoarthritis was evaluated based on pre-operative radiographs using the Kellgren and Lawrence grading system. Treatment failure, which was defined as non-union, avascular necrosis, backing out of the implant, cut out of the proximal screws, peri-prosthetic fracture, implant breakage, or conversion to hemi- or total hip arthroplasty, was evaluated for a follow-up period of four to seven years. Optimal placement of the implant (tip-apex distance (TAD) and 3-point fixation) and the effects of age, sex, the quality of reduction, implant type, fracture stability, fracture type, and time to failure were considered confounders of the relationship between failure and osteoarthritis (OA).

Results

Among the 32 cases (5.3%) of treatment failure, 12 (2%) showed evidence of osteoarthritis. After controlling for age, sex, the quality of reduction, implant type, fracture stability, fracture type, and TAD, osteoarthritis was associated a greater than threefold increase in treatment failure compared with that of patients without pre-operative evidence of osteoarthritis (OR, 3.26; 95% CI, 1.4–7.65; P = 0.006).

Conclusions

After adjusting for potential confounding factors, radiographic evidence of hip osteoarthritis at the time of hip fracture increases the incidence of treatment failure.

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Titel: Osteoarthritis is associated with increased failure of proximal femoral fracture fixation
verfasst von: Charles A. Gallagher
Christopher W. Jones
Lara Kimmel
Christopher Wylde
Anthony Osbrough
Max Bulsara
Kathryn Hird
Piers Yates
Publikationsdatum: 20.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 5/2019
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4014-8

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Osteoarthritis is associated with increased failure of proximal femoral fracture fixation