Factors Associated With Revision Surgery After Internal Fixation of Hip Fractures

Sheila Sprague; Emil H Schemitsch; Marc Swiontkowski; Gregory J Della Rocca; Kyle J Jeray; Susan Liew; Gerard P Slobogean; Sofia Bzovsky; Diane Heels-Ansdell; Qi Zhou; Mohit Bhandari; FAITH Investigators

doi:10.1097/BOT.0000000000001162

Factors Associated With Revision Surgery After Internal Fixation of Hip Fractures

J Orthop Trauma. 2018 May;32(5):223-230. doi: 10.1097/BOT.0000000000001162.

Authors

Collaborators

FAITH Investigators:
P J Devereaux, Gordon Guyatt, Martin J Heetveld, Martin Richardson, Lehana Thabane, Paul Tornetta III, Stephen D Walter, Paula McKay, Taryn Scott, Alisha Garibaldi, Helena Viveiros, Marilyn Swinton, Mark Gichuru, Lisa Buckingham, Aravin Duraikannan, Deborah Maddock, Nicole Simunovic, Julie Agel, Martin J Heetveld, Esther M M Van Lieshout, Stephanie M Zielinski, Amar Rangan, Birgit C Hanusch, Lucksy Kottam, Rachel Clarkson, Robert Haverlag, Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Trevor Stone, Darius Viskontas, H. Michael Lemke, Mauri Zomar, Karyn Moon, Raely Moon, Amber Oatt, Richard E Buckley, Paul Duffy, Robert Korley, Shannon Puloski, James Powell, Kelly Johnston, Kimberly Carcary, Melissa Lorenzo, Ross McKercher, David Sanders, Mark MacLeod, Abdel-Rahman Lawendy, Christina Tieszer, David Stephen, Hans Kreder, Richard Jenkinson, Markku Nousiainen, Terry Axelrod, John Murnaghan, Diane Nam, Veronica Wadey, Albert Yee, Katrine Milner, Monica Kunz, Wesley Ghent, Michael D McKee, Jeremy A Hall, Aaron Nauth, Henry Ahn, Daniel B Whelan, Milena R Vicente, Lisa M Wild, Ryan M Khan, Jennifer T Hidy, Chad Jennifer T, Ross Leighton, Michael Biddulph, David Johnston, Mark Glazebrook, David Alexander, Catherine Coady, Michael Dunbar, J. David Amirault, Michael Gross, William Oxner, Gerald Reardon, C. Glen Richardson, J. Andrew Trenholm, Ivan Wong, Kelly Trask, Shelley MacDonald, Gwendolyn Dobbin, Ryan Bicknell, Jeff Yach, Davide Bardana, Gavin Wood, Mark Harrison, David Yen, Sue Lambert, Fiona Howells, Angela Ward, Paul Zalzal, Heather Brien, V Naumetz, Brad Weening, Nicole Simunovic, Eugene K Wai, Steve Papp, Wade T Gofton, Allen Liew, Stephen P Kingwell, Garth Johnson, Joseph O’Neil, Darren M Roffey, Vivian Borsella, Victoria Avram, Todd M Oliver, Vicki Jones, Michelle Vogt, Clifford B Jones, James R Ringler, Terrence J Endres, Debra L Sietsema, Jane E Walker, J. Scott Broderick, David R Goetz, Thomas B Pace, Thomas M Schaller, Scott E Porter, Michael L Beckish, John D Adams, Benjamin B Barden, Aaron T Creek, Stephen H Finley, Jonathan L Foret, Garland K Gudger Jr., Richard W Gurich Jr., Austin D Hill, Steven M Hollenbeck, Lyle T Jackson, Kevin K Kruse III, Wesley G Lackey, Justin W Langan, Julia Lee, Lauren C Leffler, Timothy J Miller, R. Lee Murphy Jr., Lawrence K O’Malley II, Melissa E Peters, Dustin M Price, John A Tanksley Jr., Erick T Torres, Dylan J Watson, Scott T Watson, Stephanie L Tanner, Rebecca G Snider, Lauren A Nastoff, Shea A Bielby, Robert J Teasdall, Julie A Switzer, Peter A Cole, Sarah A Anderson, Paul M Lafferty, Mengnai Li, Thuan V Ly, Scott B Marston, Amy L Foley, Sandy Vang, David M Wright, Andrew J Marcantonio, Michael S H Kain, Richard Iorio, Lawrence M Specht, John F Tilzey, Margaret J Lobo, John S Garfi, Heather A Vallier, Andrea Dolenc, Mary Breslin, Michael J Prayson, Richard Laughlin, L. Joseph Rubino, Jedediah May, Geoffrey Ryan Rieser, Liz Dulaney-Cripe, Chris Gayton, James Shaer, Tyson Schrickel, Barbara Hileman, John T Gorczyca, Jonathan M Gross, Catherine A Humphrey, Stephen Kates, John P Ketz, Krista Noble, Allison W McIntyre, Kaili Pecorella, Craig A Davis, Stuart Weinerman, Peter Weingarten, Philip Stull, Stephen Lindenbaum, Michael Hewitt, John Schwappach, Janell K Baker, Tori Rutherford, Heike Newman, Shane Lieberman, Erin Finn, Kristin Robbins, Meghan Hurley, Lindsey Lyle, Khalis Mitchell, Kieran Browner, Erica Whatley, Krystal Payton, Christina Reeves, Lisa K Cannada, David E Karges, Sarah A Dawson, Samir Sarah A, John Esterhai, Jaimo Ahn, Derek Donegan, Annamarie D Horan, Patrick J Hesketh, Evan R Bannister, Jonathan P Keeve, Christopher G Anderson, Michael D McDonald, Jodi M Hoffman, Ivan Tarkin, Peter Siska, Gary Gruen, Andrew Evans, Dana J Farrell, James Irrgang, Arlene Luther, William W Cross III, Joseph R Cass, Stephen A Sems, Michael E Torchia, Tyson Scrabeck, Mark Jenkins, Jules Dumais, Amanda W Romero, Carlos A Sagebien, Mark S Butler, James T Monica, Patricia Seuffert, Joseph R Hsu, Daniel Stinner, James Ficke, Michael Charlton, Matthew Napierala, Mary Fan, Paul Tornetta III, Chadi Tannoury, Hope Carlisle, Heather Silva, Michael Archdeacon, Ryan Finnan, Toan Le, John Wyrick, Shelley Hess, Michael L Brennan, Robert Probe, Evelyn Kile, Kelli Mills, Lydia Clipper, Michelle Yu, Katie Erwin, Daniel Horwitz, Kent Strohecker, Teresa K Swenson, Andrew H Schmidt, Jerald R Westberg, Kamran Aurang, Gary Zohman, Brett Peterson, Roger B Huff, Joseph Baele, Timothy Weber, Matt Edison, Jessica Cooper McBeth, Karl Shively, Janos P Ertl, Brian Mullis, J. Andrew Parr, Ripley Worman, Valda Frizzell, Molly M Moore, Charles J DePaolo, Rachel Alosky, Leslie E Shell, Lynne Hampton, Stephanie Shepard, Tracy Nanney, Claudine Cuento, Robert V Cantu, Eric R Henderson, Linda S Eickhoff, E. Mark Hammerberg, Philip Stahel, David Hak, Cyril Mauffrey, Corey Henderson, Hannah Gissel, Douglas Gibula, David P Zamorano, Martin C Tynan, Deeba Pourmand, Deanna Lawson, Brett D Crist, Yvonne M Murtha, Linda K Anderson, Colleen Linehan, Lindsey Pilling, Courtland G Lewis, Stephanie Caminiti, Raymond J Sullivan, Elizabeth Roper, William Obremskey, Philip Kregor, Justin E Richards, Kenya Stringfellow, Michael P Dohm, Abby Zellar, Michiel J M Segers, Jacco A C Zijl, Bart Verhoeven, Anke B Smits, Jean Paul P M de Vries, Bram Fioole, Henk van der Hoeven, Evert B M Theunissen, Tammo S de Vries Reilingh, Lonneke Govaert, Philippe Wittich, Maurits de Brauw, Jan Wille, Peter M N Y M Go, Ewan D Ritchie, Ronald N Wessel, Eric R Hammacher, Martin J Heetveld, Gijs A Visser, Heyn Stockmann, Rob Silvis, Jaap P Snellen, Bram Rijbroek, Joris J G Scheepers, Erik G J Vermeulen, Michiel P C Siroen, Ronald Vuylsteke, Hans L F Brom, Herman Rijna, Piet A R de Rijcke, Cees L Koppert, Steven E Buijk, Richard P R Groenendijk, Imro Dawson, Geert W M Tetteroo, Milko M M Bruijninckx, Pascal G Doornebosch, Eelco J R de Graaf, Maarten van der Elst, Carmen C van der Pol, Martijne van ’t Riet, Tom M Karsten, Mark R de Vries, Laurents P S Stassen, Niels W L Schep, G Ben Schmidt, W H Hoffman, Rudolf W Poolman, Maarten P Simons, Frank H W M van der Heijden, W Jaap Willems, Frank R A J de Meulemeester, Cor P van der Hart, Kahn Turckan, Sebastiaan Festen, Frank de Nies, Robert Haverlag, Nico J M Out, Jan Bosma, Albert van Kampen, Jan Biert, Arie B van Vugt, Michael J R Edwards, Taco J Blokhuis, Jan Paul M Frölke, Leo M G Geeraedts, Jean W M Gardeniers, Edward C T H Tan, Lodewijk M S J Poelhekke, Maarten C de Waal Malefijt, Bart Schreurs, Gert R Roukema, Hong A Josaputra, Paul Keller, Peter D de Rooij, Hans Kuiken, Han Boxma, Berry I Cleffken, Ronald Liem, Steven J Rhemrev, Coks H R Bosman, Alexander de Mol van Otterloo, Jochem Hoogendoorn, Alexander C de Vries, Sven A G Meylaerts, Michiel H J Verhofstad, Joost Meijer, Teun van Egmond, Frank H W M van der Heijden, Igor van der Brand, Peter Patka, Martin G Eversdijk, Rolf Peters, Dennis Den Hartog, Oscar J F Van Waes, Pim Oprel, Harm M van der Vis, Martin Campo, Ronald Verhagen, G H Robert Albers, Arthur W Zurcher, Rogier K J Simmermacher, Jeroen van Mulken, Karlijn van Wessem, Taco J Blokhuis, Steven M van Gaalen, Luke P H Leenen, Maarten W G A Bronkhorst, Onno R Guicherit, J Carel Goslings, Robert Haverlag, Kees Jan Ponsen, Mahesh Bhatia, Vinod Arora, Vivek Tyagi, Harvinder Bedi, Ashley Carr, Hamish Curry, Andrew Chia, Steve Csongvay, Craig Donohue, Stephen Doig, Elton Edwards, Greg Etherington, Max Esser, Andrew Gong, Arvind Jain, Doug Li, Russell Miller, Ash Moaveni, Matthias Russ, Lu Ton, Otis Wang, Adam Dowrick, Zoe Murdoch, Claire Sage, Frede Frihagen, John Clarke-Jenssen, Geir Hjorthaug, Torben Ianssen, Asgeir Amundsen, Jan Egil Brattgjerd, Tor Borch, Berthe Bøe, Bernhard Flatøy, Sondre Hasselund, Knut Jørgen Haug, Kim Hemlock, Tor Magne Hoseth, Jomaas Jomaas, Thomas Kibsgård, Tarjei Lona, Gilbert Moatshe, Oliver Müller, Marius Molund, Tor Nicolaisen, Fredrik Nilsen, Jonas Rydinge, Morten Smedsrud, Are Stødle, Axel Trommer, Stein Ugland, Anders Karlsten, Guri Ekås, Elise Berg Vesterhus, Anne Christine Brekke, Ajay Gupta, Neeraj Jain, Farah Khan, Ateet Sharma, Amir Sanghavi, Mittal Trivedi, Anil Rai, Kamal Rai, Vineet Yadav, Sanjay Singh, Kamal Rai, Kevin Tetsworth, Geoff Donald, Patrick Weinrauch, Paul Pincus, Steven Yang, Brett Halliday, Trevor Gervais, Michael Holt, Annette Flynn, Amal Shankar Prasad, Vimlesh Mishra, D C Sundaresh, Angshuman Khanna, Joe Joseph Cherian, Davy J Olakkengil, Gaurav Sharma, Marinis Pirpiris, David Love, Andrew Bucknill, Richard J Farrugia, Hans-Christoph Pape, Matthias Knobe, Roman Pfeifer, Peter Hull, Sophie Lewis, Simone Evans, Rajesh Nanda, Rajanikanth Logishetty, Sanjeev Anand, Carol Bowler, Akhil Dadi, Naveen Palla, Utsav Ganguly, B. Sachidananda Rai, Janakiraman Rajakumar, Andrew Jennings, Graham Chuter, Glynis Rose, Gillian Glynis, Callum Clark, Kate Eke, Mike Reed, Dominic Inman, Chris Herriott, Christine Dobb

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
² Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
³ Department of Surgery, University of Western Ontario, London, ON, Canada.
⁴ Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
⁵ Department of Orthopaedic Surgery, University of Missouri, School of Medicine, Columbia, MO.
⁶ Department of Orthopaedic Surgery, Greenville Health System, Greenville, SC.
⁷ Department of Orthopaedic Surgery, The Alfred, Melbourne, Victoria, Australia.
⁸ Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.

Abstract

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).

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arthroplasty, Replacement, Hip
Device Removal
Female
Femoral Neck Fractures / surgery*
Fracture Fixation, Internal / adverse effects*
Fracture Fixation, Internal / methods*
Fracture Healing
Humans
Male
Prognosis
Randomized Controlled Trials as Topic
Reoperation*
Risk Factors
Treatment Outcome

Grants and funding

R01 AR055267/AR/NIAMS NIH HHS/United States