Rate of conversion to secondary arthroplasty after femoral neck fractures in 796 younger patients treated with internal fixation: a Swedish national register-based study

Sebastian Strøm Rönnquist; Johan Lagergren; Bjarke Viberg; Michael Möller; Cecilia Rogmark

doi:10.2340/17453674.2022.3038

Authors

Sebastian Strøm Rönnquist Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0002-0762-9691
Johan Lagergren Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden; Western Hospital Group, Alingsås, Sweden https://orcid.org/0000-0003-1646-0733
Bjarke Viberg Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark https://orcid.org/0000-0001-5169-4282
Michael Möller Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, Sweden; Swedish Fracture Register, Gothenburg, Sweden
Cecilia Rogmark Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden; Swedish Fracture Register, Gothenburg, Sweden; Swedish Arthroplasty Register, Gothenburg, Sweden https://orcid.org/0000-0002-6556-4320

DOI:

https://doi.org/10.2340/17453674.2022.3038

Keywords:

Conversion arthroplasty, Femoral neck fracture, Internal fixation, Young and middle-age

Abstract

Background and purpose: In younger patients with a femoral neck fracture (FNF), internal fixation is the recommended treatment regardless of displacement. Healing complications are often treated with arthroplasty. We determined the rate of conversion to arthroplasty up to 5 years after fixation of either undisplaced FNFs (uFNFs) or displaced FNFs (dFNFs).
Patients and methods: The study was based on prospectively collected data from the Swedish Fracture Register (SFR) and the Swedish Arthroplasty Register (SAR). FNFs in patients aged < 60 treated with parallel pins/screws or sliding hip screws (SHS) registered in SFR 2012–2018 were cross-referenced with conversions to arthroplasty registered in SAR until 2019. The cumulative conversion and mortality rates were determined by Kaplan–Meier analyses and patient- and surgery-dependent risk factors for conversion by Cox regression analyses.
Results: We included 407 uFNFs and 389 dFNFs (median age 52, 59% men). The 1-year conversion rate was 3% (95% CI 1–5) for uFNFs and 9% (CI 6–12) for dFNFs. Corresponding results at 5 years were 8% (CI 5–11) and 25% (CI 20–30). Besides a displaced fracture, age 50–59 was associated with an increased rate of conversion in uFNFs. This older group also had a higher mortality rate, compared with patients aged < 50. There was no sex difference for mortality.
Interpretation: Adults aged under 60 with uFNFs and dFNFs face an 8–25% risk, respectively, of conversion to arthroplasty within 5 years after internal fixation. This is new and pertinent information for surgeons as well as patients.