Multivariant Analysis on the Long‐term Results of Hemiarthroplasty After Subcapital Fracture of the Femur

To the Editor: Fractures at the hip joint have become an endemic problem of modern medicine. With increasing life expectancy, it is estimated that every third person older than age 80 will incur a hip fracture, one-third of which are of the subcapital type.1,2,3 Hemiarthroplasty is a more common surgical solution than total joint arthroplasty in most orthopedic services because it involves a simple, cheap, short operation and enables immediate initiation of the rehabilitation process.5 Proper selection of patients before surgery influences the postoperative results greatly. Some of the parameters reported to influence the outcome of surgery include age, sex (males have more favorable results), preoperative socioeconomic status, and previous disease history. Ninety-three patients who underwent hemiarthroplasty of the hip joint as a result of subcapital fracture of the femur during 1987 were included in this retrospective study. There were 69 females and 24 males, with ages ranging from 63 to 98 years. The major indications for surgery at our hospital are (1) any patient who could walk independently (even with crutches or walker) before the fracture event and (2) good medical condition (enough for postoperative cooperation). The 40 parameters analyzed in this study were evaluated at the end of the first year postoperatively and at 5 years postoperatively. These parameters are divided into several groups: Demography and social information; the trauma; associated diseases; operative parameters; immediate postoperative complications; postoperative social details; and late postoperative evaluation. There were 67 (79%) patients alive 1 year after surgery. Only 14 patients (16.5), 10 females and four males, were alive 5 years after surgery. Analysis of the results showed that the only statistically significant parameter for prediction of functional survival in this operation was the patients age (P < .02). Other parameters that had no clear statistical validity yet were very close to it were: existence of preoperative dementia; cementation of the prosthesis at operation; and infection or dislocation at the immediate postoperative course. Parameters that are believed by many surgeons to have a major influence on the operative outcome, such as lapsed time awaiting for surgery, related diseases (other than OBS), postoperative rehabilitation destination, and length of hospitalization, had no statistical influence on the survival in our study. In conclusion, our long-term multivariant analysis indicates that every effort, medical and socioeconomic, should be invested in preventing the downhill deterioration of older patients with sub-capital fracture of the hip joint. Moreover, because fractures of the hip joint are so common, more prophylactic measures, such as treatment of osteoporosis and adaptation of housing conditions to meet the needs of older people (to prevent slips and falls), should be taken to prevent their occurrence: