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Introduction: Sustaining a hip fracture is a life changing event for many elderlies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home. This study aimed to i) determine age-stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission.Methods: Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide administrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative incidence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities.Results: A total of 53,157 patients were included. One-year risk increased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk factors were pre-injury home care, Parkinson's disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary disease, diabetes and cancer did not increase the risk of nursing home admission.Conclusion: Future initiatives aimed to reduce loss of independence and nursing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical comorbidity. [ABSTRACT FROM AUTHOR]

OBJECTIVES Patients undergoing hip fracture surgery have a 10 times increased risk of stroke compared with the general population. We aimed to evaluate the association between the CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke/TIA [transient ischemic attack]/systemic embolism (2 points), vascular disease, age 65‐74 years, and female sex) score and the risk of stroke, thromboembolism, and all‐cause mortality in patients with hip fracture with or without atrial fibrillation (AF). DESIGN Nationwide prospective cohort study. SETTING Danish hospitals. PARTICIPANTS Subjects were all incident hip fracture patients in Denmark age 65 years and older with surgical repair procedures between 2004 and 2016 (n = 78,096). Participants were identified using the Danish Multidisciplinary Hip Fracture Registry. MEASUREMENTS We calculated incidence rates, cumulative incidences, and hazard ratios (HRs) with 95% confidence intervals (CIs) by CHA2DS2‐VASc score, stratified on AF history. RESULTS: The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA2DS2‐VASc score, and it was 1.9% for patients with a score of 1 and 8.6% for patients with a score above 5 in the AF group. Corresponding incidences in the non‐AF group were 1.6% and 7.6%. Compared with a CHA2DS2‐VASc score of 1, adjusted HRs were 5.53 (95% CI = 1.37‐22.24) among AF patients and 4.91 (95% CI = 3.40‐7.10) among non‐AF patients with a score above 5. A dose‐response–like association was observed for all cardiovascular outcomes. All‐cause mortality risks and HRs were substantially higher for all CHA2DS2‐VASc scores above 1 in both the AF group and the non‐AF group. CONCLUSION: Among patients with hip fracture, a higher CHA2DS2‐VASc score was associated with increased risk of stroke, thromboembolism, and death. This finding applied both to patients with and without AF. Patients with high CHA2DS2‐VASc scores had almost similar absolute risks for cardiovascular outcomes, irrespective of AF. J Am Geriatr Soc 68:1698‐1705, 2020. [ABSTRACT FROM AUTHOR]

Purpose: Predictors of outcome after femoroacetabular impingement (FAI) surgery are not well-documented. This study presents data from the Danish Hip Arthroscopy Registry (DHAR) for such analyses. The purpose of this study was to identify predictors of poor outcome after FAI surgery in a Danish FAI population. The primary hypothesis was that older patients, patients with severe cartilage damage and female patients might have inferior outcome results compared with younger patients, patients with minor cartilage damage and male patients.Methods: Radiological and surgical data as well as patient-reported outcome measures (PROM) from FAI patients in DHAR between January 2012 and May 2015 were collected. PROMs consisting of Copenhagen Hip and Groin Outcome Score (HAGOS), quality of life (EQ-5D), Hip Sports Activity Scale (HSAS) and Numeric Rating Scale (NRS) pain scores were assessed. The patients were divided into three age groups (< 25, 25-39 and ≥ 40 years). Cartilage injuries were classified according to International Cartilage Repair Society (ICRS) (femoral side) and modified Becks (acetabular side) classifications. A non-parametric statistic method was used to analyze the differences between the preoperative and postoperative PROM values.Results: Data from 2054 FAI procedures in DHAR was collected. 53% of the procedures were done in female patients. All HAGOS sub-scales, EQ-5D, HSAS and NRS pain (rest and walk) demonstrated significant improvements in all age groups at follow-up. Comparison between age groups demonstrated poorer outcomes in both older age groups when compared with the < 25 years age group at 1- and 2-year follow-ups. Higher degrees of femoral and acetabular cartilage injury did have a negative influence on outcome at follow-up. Comparison between genders demonstrated lower preoperative outcomes in females and lower outcome score (HSAS) 1 and 2 years after FAI surgery.Conclusions: Age above 25 and major cartilage injury might negatively affect the outcome of surgery, however, gender could not be identified as a negative predictor of clinical outcome after FAI surgery, but might negatively affect sports participation in females.Level Of Evidence: III, prospective cohort study. [ABSTRACT FROM AUTHOR]

Introduction: In Denmark, 20% of all registered total hip arthroplasties (THA) from 1995 to 2014 has been patients younger than 60 years with primary idiopathic osteoarthritis (OA). It is speculated that hip malformations may be a major contributor to early OA development. It has been shown that hip malformation may compromise implant position and, therefore, identifying and knowing the incidence of malformations is important. Our aim was to assess the prevalence and type of hip malformations in a cohort of younger patients undergoing THA.Materials and Methods: In this prospective two center cohort study, 95 consecutive patients (106 hips) met the inclusion criteria. One observer performed radiographic measurements for malformations and radiographic OA. Inter- and intraobserver variability was assessed.Results: From 95 patients (male n = 52 and female n = 43) age ranged from 35 to 59 years and prevalences of hip malformations were; CAM-deformity 50.9 and 25.5%, coxa profunda 33 and 27.4%, acetabular retroversion 33 and 29.2%, and acetabular dysplasia 10.4 and 3.8%. All patients showed minimum of one malformation. Prevalences of Tönnis grade 0-1 were 22.6% and 2-3 were 77.4%.Conclusion: All patients showed malformations, especially high prevalences were found for CAM-deformity, coxa profunda and acetabular retroversion. Identifying these malformations is fairly simple and recognizing the high prevalence may help surgeons avoid pitfalls during implant positioning in THA surgery. Further, focus on hip malformations may facilitate correct referral to joint-preserving surgery before OA develops. [ABSTRACT FROM AUTHOR]

Background: Revision for prosthetic joint infection (PJI) has a major effect on patients' health but it remains unclear if early PJI after primary THA is associated with a high mortality.Questions/purposes: (1) Do patients with a revision for PJI within 1 year of primary THA have increased mortality compared with patients who do not undergo revision for any reason within 1 year of primary THA? (2) Do patients who undergo a revision for PJI within 1 year of primary THA have an increased mortality risk compared with patients who undergo an aseptic revision? (3) Are there particular bacteria among patients with PJI that are associated with an increased risk of death?Methods: This population-based cohort study was based on the longitudinally maintained Danish Hip Arthroplasty Register on primary THA performed in Denmark from 2005 to 2014. Data from the Danish Hip Arthroplasty Register were linked to microbiology databases, the National Register of Patients, and the Civil Registration System to obtain data on microbiology, comorbidity, and vital status on all patients. Because reporting to the register is compulsory for all public and private hospitals in Denmark, the completeness of registration is 98% for primary THA and 92% for revisions (2016 annual report). The mortality risk for the patients who underwent revision for PJI within 1 year from implantation of primary THA was compared with (1) the mortality risk for patients who did not undergo revision for any reason within 1 year of primary THA; and (2) the mortality risk for patients who underwent an aseptic revision. A total of 68,504 primary THAs in 59,954 patients were identified, of those 445 primary THAs underwent revision for PJI, 1350 primary THAs underwent revision for other causes and the remaining 66,709 primary THAs did not undergo revision. Patients were followed from implantation of primary THA until death or 1 year of followup, or, in case of a revision, 1 year from the date of revision.Results: Within 1 year of primary THA, 8% (95% CI, 6%-11%) of patients who underwent revision for PJI died. The adjusted relative mortality risk for patients with revision for PJI was 2.18 (95% CI, 1.54-3.08) compared with the patients who did not undergo revision for any cause (p < 0.001). The adjusted relative mortality risk for patients with revisions for PJI compared with patients with aseptic revision was 1.87 (95% CI, 1.11-3.15; p = 0.019). Patients with enterococci-infected THA had a 3.10 (95% CI, 1.66-5.81) higher mortality risk than patients infected with other bacteria (p < 0.001).Conclusions: Revision for PJI within 1 year after primary THA induces an increased mortality risk during the first year after the revision surgery. This study should incentivize further studies on prevention of PJI and on risk to patients with the perspective to reduce mortality in patients who have had THA in general and for patients with PJI specifically.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background and purpose Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results. Methods 2,000 consecutive patients over 50 years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient records. Results 931 of 1,000 operative procedures were performed according to the algorithm, as compared to only 726 of 1,000 prior to its introduction (p < 0.001). After implementation of the algorithm, junior registrars still performed half of the operations, but unsupervised procedures declined from 192 of 1,000 to 105 of 1,000 (p < 0.001). The rate of reoperations declined from 18% to 12% (p < 0.001 in a multiple Cox regression analysis), with a decline of 24% to 18% for intracapsular fractures and a decline of 13% to 7% for extracapsular fractures. The proportion of bed-days caused by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced. Interpretation It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised the rate of supervision and reduced the rate of reoperations. The reduced reoperation rate saved many hospital bed-days. [ABSTRACT FROM AUTHOR]

Background There is a 5- to 8-fold increased risk of mortality during the first 3 months after a hip fracture. Several risk factors are known. We studied the predictive value (for mortality) of routine blood tests taken on admission. Methods 792 hip fracture patients were included prospectively; blood tests were taken on admission. Follow-up data on mortality were obtained from the civil registration system. Patients were divided into 2 groups based on whether they had survived at least 90 days after the hip fracture. To estimate which laboratory tests could be used to predict outcome, we used receiver operation characteristic (ROC) curves. Results 3-month mortality could be predicted with 69% accuracy from the level of plasma creatinine in standard admission blood tests. The mortality in patients with elevated levels of creatinine was almost 3-fold that of the patients with normal creatinine. Mortality was also associated with age, low blood hemoglobin, high plasma potassium, and low plasma albumin levels. Interpretation Our findings could be of use in identifying patients who might benefit from increased attention perioperatively. [ABSTRACT FROM AUTHOR]

Background Trabecular metal has shown promising results in experimental studies of bone ingrowth. Several clinical studies support these results. However, until now, no randomized clinical radiostereometric analysis (RSA) studies have been published. In this randomized RSA trial, we compared a new acetabular cup with a surface made of tantalum trabecular metal and a cup with a titanium fiber-mesh surface. Patients and methods Between 2004 and 2006, we operated 60 patients with noninflammatory hip arthritis. The patients were randomized to receive either an uncemented cup with a titanium fiber-mesh surface (Trilogy cup) or a cup with a trabecular tantalum surface (Monoblock cup). After 2 years, 50 patients had completed the study. The primary endpoint was cup migration within the first 2 years after surgery; the secondary endpoints were change in bone mineral density and Harris hip score at 3 months. Results Both cup types showed excellent fixation. RSA revealed minimal translation and rotation at 2 years. There was no statistically significant difference between the cup types with regard to translation. However, less rotation along the transverse axis was seen in the trabecular metal cups than in the fiber mesh cups: mean --0.01ºº (95% CI: --0.11 to 0.12) for trabecular metal cups and --0.60ºº (--0.72 to --0.48) for fiber-mesh cups (p == 0.04). The degree of periprosthetic bone loss was similar between the cup types in any of the regions of interest at 2 years of follow-up. 3 months postoperatively, we found a similar increase in Harris hip score in both groups: from around 50 to over 90. Interpretation We found promising early results concerning fixation of trabecular metal components to the acetabular host bone. However, we recommend a longer observation period to evaluate the outcome of this new cup design. [ABSTRACT FROM AUTHOR]