Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal. Conclusions: Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020).
Bibliographical noteFunding Information:
S. Sprague reports employment/salary from McMaster University, other from Global Research Solutions, outside the submitted work. E. H. Schemitsch reports personal fees from Stryker, personal fees from Smith & Nephew, personal fees from Zimmer, personal fees from Acumed, personal fees from Amgen, personal fees from Sanofi, personal fees from Pendopharm, outside the submitted work. G. J. Della Rocca reports grants from National Institutes of Health, during the conduct of the study, personal fees from Bioventus, personal fees from DePuy-Synthes, personal fees from Wright-Tornier, being a shareholder for Amedica, having stock options from the Orthopaedic Implant Company, having stock options from LuminCare, having stock options from Mergenet, and personal fees from AO Trauma, outside the submitted work. K. J. Jeray reports being on the board of committee members for the Orthopaedic Trauma Association, personal fees from Zimmer Inc, personal fees from Lilly USA, LLC, personal fees from Pacira, being on the board and a member of the American Orthopaedic Association, being an unpaid consultant for Bioventus, LLC, being on the editorial board for Journal of Bone and Joint Surgery, being on the editorial board for the Journal of Orthopaedic Trauma, being on the editorial board for the Journal of the American Academy of Orthopaedic Surgeons, being on the board for Southeastern Fracture Consortium, nonfinancial support from Synthes, and personal fees from Radius, outside the submitted work. M. Bhandari reports grants from Canadian Institutes of Health Research, grants from National Institutes of Health, grants from Stichting NutsOhra, grants from The Netherlands Organisation for Health Research and Development, grants from Physicians’ Services Incorporated, grants from Stryker Inc., during the conduct of the study, grants and personal fees from Stryker Inc., personal fees from Smith & Nephew, grants and personal fees from Amgen, grants from DePuy, grants and personal fees from Eli Lilly, grants and personal fees from DJO Global Inc., personal fees from Zimmer, personal fees from Ferring, grants from the Canada Research Chair in Musculoskeletal Trauma, outside the submitted work. The remaining authors report no conflict of interest.
Data for this study were provided by the FAITH trial. The FAITH trial was supported by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), the Netherlands Organisation for Health Research and Development (80-82310-97-11032), Physicians’ Services Incorporated. M. Bhandari was also funded, in part, through the Early Research Award Program that provided funding for the present study and by a Canada Research Chair in Musculoskeletal Trauma which is unrelated to the present study (McMaster University, Hamilton, ON, Canada). The FAITH trial was also supported by the National Institute of Arthritis and Musculo-skeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham & Tees Valley Comprehensive Local Research Network that operates as part of the National Institute for Health Research Compre-hensive Clinical Research Network in England. The funding sources had no role in design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.
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- cancellous screws
- femoral neck fracture
- internal fixation
- revision surgery
- sliding hip screw