Clinical results after hip fracture - with special focus on hip arthroplasty

Sammanfattning: Hip fractures are of major concern worldwide, but even if literature isabundant, there are still gaps to fill. The global outcome needs to be betterunderstood, including patient-reported outcome. Many studies focus onimproving surgical outcome, with less focus on medical complications. Thetrue number of adverse events after hip fracture surgery is unknown. Femoralneck fractures (FNFs), constituting half of all hip fractures, are commonlytreated with arthroplasty, but evidence on whether to use hemiarthroplasty(HA) or total hip arthroplasty (THA) is unclear.Paper I is a retrospective cohort study of all patients with hip fracture at ourhospital during one year, examining complications and patient-reportedoutcome. Absence of medical and hip complications correlated to improvedsatisfaction and pain. Medical complications alone correlated to loss offunction. One-third regained pre-fracture mobility and one-third receivedenough rehabilitation.Paper II is an observational cohort study comparing two matched groups ofpatients with THA or HA as treatment for FNF. THA had significantly reducedrisk of revision and reoperation, and was associated with reduced mortality.Papers III and IV are observational cohort studies on patients treated with THAor HA for FNF, with adjustment for comorbidity and socioeconomicbackground. A majority suffered an adverse event, one-third suffered amedical complication and one-fifth a hip complication. THA was associatedwith fewer medical complications and lower mortality but more hipcomplications, even after matching according to comorbidity andsocioeconomic variables.In conclusion, complications are important for outcome and improving theoverall care of hip fracture patients is as important as the choice of surgicaltreatment. THA may perform better than HA in some aspects in selectedpatients, but an unbiased comparison between the two types of arthroplastiesis difficult to achieve.