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Background The purpose of this study was to compare the cumulative incidence of postoperative periprosthetic fracture (PPF) in a cohort of femoral neck fracture (FNF) patients treated with two commonly used cemented stems: either a collarless, polished, tapered Exeter stem or the anatomic Lubinus SP2 stem. Methods In this retrospective multicenter cohort study of a consecutive series of patients, we included 2528 patients of age 60 years and above with an FNF who were treated with either hemiarthroplasty or total hip arthroplasty using either a polished tapered Exeter stem or an anatomic Lubinus SP2 stem. The incidence of PPF was assessed at a minimum of 2 years postoperatively. Results The incidence of PPF was assessed at a median follow-up of 47 months postoperatively. Thirty nine patients (1.5%) sustained a PPF at a median of 27 months (range 0–96 months) postoperatively. Two of the operatively treated fractures were Vancouver A (5%), 7 were Vancouver B1 (18%), 10 were Vancouver B2 (26%), 7 were Vancouver B3 (18%), and 13 were Vancouver C (32%). The cumulative incidence of PPF was 2.3% in the Exeter group compared with 0.7% in the SP2 group (p p Conclusions The Exeter stem was associated with a higher risk for PPF than the Lubinus SP2 stem. We suggest that the tapered Exeter stem should be used with caution in the treatment of FNF. Trial registration The study was registered at clinicaltrials.gov (identifier: NCT03326271).

Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the "obesity paradox." The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture.This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients ≥65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multivariable regression models were used to estimate the associations.Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of22 kg/m had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of22 kg/m had clearly worse odds compared with patients who were of normal weight, overweight, or obese.The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective: This study examines patient factors to identify risks of 12-month mortality following periprosthetic femur fractures. Hospital charges were analyzed to quantify the financial burden for treatment modalities. Methods: Data were retrospectively analyzed from a prospective database at a university hospital setting. One-hundred and thirteen patients with a periprosthetic fracture of the proximal or distal femur were identified. Risk factors for 12-month mortality were analyzed, and financial data were compared between the various treatment modalities. Results: In all, 14% of patients died (16 of 113) within 3 months and the 1-year mortality was 17.7% (20 of 113). Patients who died within 1 year had higher hospital charges (US$33 880 ± 25 051 vs US$22 886 ± 16 841; P = .01) and were older (87.6 ± 8.5 vs 81.5 ± 8.6; P = .004). Logistic regression analysis revealed age was the only significant predictor of 1-year mortality (P = .029, odds ratio 1.1). Analysis of financial data revealed 4 distinct groups (P < .05 between groups). Distal femoral revision arthroplasty (RA-DF) generated the highest hospital charges of US$91 035 ± 25 579 (n = 3). The second most highly charged group included proximal femoral fractures treated with revision arthroplasty (US$34 078 ± 17 832; n = 20) and hemi/total hip arthroplasty (THA; US$41 556 ± 23 651; n = 8). The third most charged group underwent open reduction internal fixation of the proximal (US$18 706 ± 6829; n = 35) and distal (US$22 381 ± 10 835; n = 35) femur. Nonoperative treatment generated the lowest charges (US$6426 ± 2899; n = 11). On average, the hospital lost money treating patients with RA-DF (US$−19 080 ± 2022 per patient) and hemi/THA (US$−6594 ± 9305 per patient), while all other treatment groups were profitable. Conclusion: One-year mortality after periprosthetic femur fractures was 17.7%, is mostly influenced by age, and 80% of deaths occur within 3 months. Patients treated with primary/revision arthroplasty generate more hospital charges than internal fixation. The average patient treated with revision arthroplasty of the distal femur or hemi/THA for a periprosthetic femur fractures resulted in net financial losses for the hospital.

Background and purpose — Displaced femoral neck fractures (FNFs) are associated with high rates of mortality during the first postoperative year. The Sernbo score (based on age, habitat, mobility, and mental state) can be used to stratify patients into groups with different 1-year mortality. We assessed this predictive ability in patients with a displaced FNF treated with a hemiarthroplasty or a total hip arthroplasty. Patients and methods — 292 patients (median age 83 (65–99) years, 68% female) with a displaced FNF were included in this prospective cohort study. To predict 1-year mortality, we used a multivariate logistic regression analysis including comorbidities and perioperative management. A receiver operating characteristic (ROC) analysis was used to evaluate the predictive ability of the Sernbo score, which was subsequently divided in a new manner into a low, intermediate, or high risk of death during the first year. Results — At 1-year follow-up, the overall mortality rate was 24%, and in Sernbo’s low-, intermediate-, and high-risk groups it was 5%, 22%, and 51%, respectively. The Sernbo score was the only statistically significant predictor of 1-year mortality: odds ratio for the intermediate-risk group was 4.2 (95% Cl: 1.5–12) and for the high-risk group it was 15 (95% CI: 5–40). The ROC analysis showed a fair predictive ability of the Sernbo score, with an area under the curve (AUC) of 0.79 (95% CI: 0.73–0.83). Using a cutoff of less than 11 points on the score gave a sensitivity of 61% and a specificity of 83%. Interpretation — The Sernbo score identifies patients who are at high risk of dying in the first postoperative year. This scoring system could be used to better tailor perioperative care and treatment in patients with displaced FNF.

Introduction Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population. The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty. Methods A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution. 33 (4.5%) of the hips developed an early (Results DAIR eradicated the PJI in 82% (23/28) of patients at a median follow-up of 31 (SD 29.8) months of the infected hips. The logistic regression analysis indicated that 2 or more changes of the primary dressing due to wound bleeding was associated with an increased risk for developing PJI (OR 4.9, 95% 1.5 to 16.1, p = 0.01). Conclusions The short-term success-rate of DAIR was unexpectedly favourable in this fragile patient population; the results being on par with that after PJI in osteoarthritis patients. The need for repeated bandage changes postoperatively indicates an increased risk for PJI and should prompt early surgical intervention.

Background and purpose - Recent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished ...