Risk factors affecting mortality and patient survival in patients above 60 years undergoing hemiarthroplasty due to hip fracture

Abstract

Objective: The aim of this study was to retrospectively determine the risk factors affecting mortality and survival after partial prosthesis treatment of proximal femoral fractures in elderly patients. Patients and Methots: In this study, patients aged 60 years and over who underwent hemiarthroplasty with the diagnosis of proximal fracture of the femur between 2013 and 2016 were evaluated retrospectively. Those who do not have adequate imaging and cannot be reached by telephone were not included in the study. 94 patients (58 females and 36 males) were included in the study. Age, gender, fracture type and side, Garden and Evans Scores, Singh Index, ASA values, additional diseases, when they were operated after falling, stem type used, anesthesia methods, hospitalization periods, survivors Harris hip scores, UCLA scores, Barthel Index and VAS scores a total of 17 parameters were evaluated. Results: The mean age of the patients was 80.5 (± 6.85); The mean age of the male patients was 78.6 (± 7.51) and the mean age of the female sex was 81.7 (± 6.16). When the fracture types of the cases were examined, it was seen that 58 patients (61%) had intertrochanteric and 36 patients (39%) had collum femoris fracture. The mean time from the day of fracture to operation was calculated as 5.61 (± 11.00). Hypertension, diabetes, and coronary artery diseases were the most common diseases. Sixty-four out of 94 patients died, and 30 were still alive during our study. It was seen that 11 of the patients died in the first month, 11 of them died between 1-6 months postoperatively, 4 of them died between 6-12 months, 15 of them died between 12-24 months, 23 of them died between 24-60 months. It was seen that 93% (n = 28) of the patients still alive were operated on in the first 5 days after fracture. Conclusion: Hip fractures are a serious cause of mortality and morbidity in the elderly. Physical and mental capacity of the patients before fracture is one of the most important predictors of postoperative mortality and morbidity. The rehabilitation process of patients who use a large number of drugs due to additional diseases and have a short life expectancy is more difficult than other patients. The main goal is to return patients to their daily lives in the shortest possible time. ASA values and comorbidities were found to be important in postoperative mortality.

Keywords

• Aged
• comorbidity
• hip fractures
• mortality
• osteoporosis
• complications
• prognosis
• quality of life
• risk factors

References

1. 1. Tolga A, Ceylan BG, Özmeriç A, EROĞLU F, Yavuz L, Heybeli N, et al. The effects of related factors on one-and two-year mortality after a hip fracture in elderly Turkish patients. Trakya Univ Tip Fak Derg. 2010;27(2):127-31.
2. 2. McKinley J, Robinson C. Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. JBJS. 2002;84(11):2010-5.
3. 3. Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients. Acta orthopaedica. 2006;77(4):638-43.
4. 4. Kyle RF. Fractures of the proximal part of the femur. JBJS. 1994;76(6):924-50.
5. 5. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporosis international. 1994;4(6):368-81.
6. 6. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. Jama. 2001;286(22):2815-22.
7. 7. Wazir N, Mukundala V, Choon D. Early results of prosthetic hip replacement for femoral neck fracture in active elderly patients. Journal of Orthopaedic Surgery. 2006;14(1):43-6.
8. 8. Anderson L, Hanisa Jr W. Waring TL: FemoraLhead prostheses. J Bone Joint Surg A. 1964;46:1049-65.

9. 9. Seckin B. Kollum Femoris Kırıklarında Unipolar ve Bipolar Parsiyel Protezlerin Karşılaştırılması. Uzmanlık Tezi Sağlık Bakanlığı Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, İstanbul. 2003.
10. 10. Van den Bekerom M, Hilverdink E, Sierevelt I, Reuling E, Schnater J, Bonke H, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. The Journal of bone and joint surgery British volume. 2010;92(10):1422-8.
11. 11. Somashekar SVK, Murthy JS. Treatment of femoral neck fractures: unipolar versus bipolar hemiarthroplasty. Malaysian orthopaedic journal. 2013;7(2):6.
12. 12. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. The Journal of bone and joint surgery American volume. 1995;77(10):1551-6.
13. 13. Sexson SB, Lehner JT. Factors affecting hip fracture mortality. Journal of orthopaedic trauma. 1987;1(4):298-305.
14. 14. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clinical orthopaedics and related research. 1984(186):45-56.
15. 15. Sener M, Onar V, Kazlmoğlu C, Yağdi S. Mortality and morbidity in elderly patients who underwent partial prosthesis replacement for proximal femoral fractures. Eklem hastaliklari ve cerrahisi= Joint diseases & related surgery. 2009;20(1):11-7.
16. 16. Doruk H, Mas MR, Yıldız C, Sonmez A, Kýrdemir V. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Archives of gerontology and geriatrics. 2004;39(2):179-85.
17. 17. Oztürk I, Toker S, Ertürer E, Aksoy B, Seckin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. Acta Orthop Traumatol Turc. 2008;42(1):16-21.
18. 18. Hamlet WP, Lieberman J, Freedman E, Dorey F, Fletcher A, Johnson E. Influence of health status and the timing of surgery on mortality in hip fracture patients. American journal of orthopedics (Belle Mead, NJ). 1997;26(9):621-7.
19. 19. Ono NK, Lima GDdA, Honda EK, Polesello GC, Guimarães RP, Ricioli Júnior W, et al. Hemiarthroplasty in the treatment of fractures of the femoral neck. Revista brasileira de ortopedia. 2010;45(4):382-8.
20. 20. Hedbeck CJ. Arthroplasty in patients with femoral neck fractures: Inst för klinisk forskning och utbildning, Södersjukhuset/Dept of Clinical …; 2011.
21. 21. Salvakçı N. Parsiyel kalça protezi uygulanan femur boyun kırıklarında sonuçların değerlendirilmesi [Uzmanlık Tezi]. Sivas1997.
22. 22. Şener M, Onar V, Kazımoğlu C, Yağdı S. Parsiyel profitez ile tedavi edilen yaşlı femur üst uç kırıklarında mortalite ve morbidite ilişkisi. Joint Dis Rel Surg. 2009;20(1):11-7.
23. 23. Çopuroglu C, Ünver KV, Özcan M, Çiftdemir M, Turan FN, Çopuroğlu E. Kalçası Kırık Hastalarda Tespit Edilen Risk Faktörlerinin İncelenmesi. Bakırköy Tıp Dergisi. 2011;7:136-41.
24. 24. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. Journal of orthopaedic trauma. 1997;11(3):162-5.
25. 25. Merchant R, Lui K, Ismail N, Wong H, Sitoh Y. The relationship between postoperative complications and outcomes after hip fracture surgery. Ann Acad Med Singapore. 2005;34(2):163-8.
26. 26. Hagino T, Ochiai S, Wako M, Sato E, Maekawa S, Senga S, et al. A simple scoring system to predict ambulation prognosis after hip fracture in the elderly. Archives of orthopaedic and trauma surgery. 2007;127(7):603-6.
27. 27. Schürch MA, Rizzoli R, Mermillod B, Vasey H, Michel J-P, Bonjour JP. A prospective study on socioeconomic aspects of fracture of the proximal femur. Journal of Bone and Mineral Research. 1996;11(12):1935-42.
28. 28. Beaupre LA, Jones CA, Saunders LD, Johnston DWC, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. Journal of general internal medicine. 2005;20(11):1019-25.
29. 29. Sircar P, Godkar D, Mahgerefteh S, Chambers K, Niranjan S, Cucco R. Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours. American journal of therapeutics. 2007;14(6):508-13.
30. 30. Roche J, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. Bmj. 2005;331(7529):1374.