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A Review of Total Hip Arthroplasty Comparison in FNF and OA Patients
Jakub Szczesiul1,2, Marek Bielecki1,2
1Department of Orthopedic, Traumatology and Hand Surgery, Medical University of Białystok, Białystok, Poland.
Insights
Patients with femoral neck fractures (FNF) are more fragile than those with osteoarthritis (OA) undergoing total hip arthroplasty (THA). FNF patients require longer hospital stays and have higher complication and readmission rates, necessitating tailored care systems.
Area of Science:
- Orthopedics
- Geriatric Surgery
- Health Services Research
Background:
- Total hip arthroplasty (THA) is a common procedure for hip conditions like femoral neck fracture (FNF) and osteoarthritis (OA).
- Healthcare systems often overlook the distinct care needs of FNF and OA patients undergoing THA.
- Differences in preoperative and postoperative pathways between FNF and OA patients are critical for effective management.
Purpose of the Study:
- To compare and contrast the demographics, comorbidities, complications, and treatment outcomes of patients undergoing THA for FNF versus OA.
- To highlight the nuanced differences in care pathways for these two patient groups.
Main Methods:
- A systematic review of retrospective cohort studies published between 2013 and 2019.
- Data extraction included patient demographics, comorbidities, complications, and treatment outcomes.
- Findings were tabulated and cross-checked for reliability.
Main Results:
- The average FNF patient was older (76.8 years) and more likely female (68.96%) compared to OA patients (69.15 years, 5.24% female).
- FNF patients experienced over 3 times more complications, longer hospitalizations (approx. 3 days), and higher rates of second surgeries (3.7% vs 1.5%) and unplanned readmissions (6.57% vs 2.93%).
- A higher percentage of OA patients (59.57%) received lower ASA classifications compared to FNF patients (34.63%).
Conclusions:
- Patients with femoral neck fractures represent a particularly vulnerable group requiring specialized perioperative and postoperative care.
- Enhanced, cost-comprehensive care systems are essential to meet the unique needs of FNF patients.
- Recognizing and addressing the distinct care requirements for FNF and OA patients undergoing THA is crucial for improving patient outcomes.
Background:
Worldwide, total hip arthroplasty (THA) has become one of the most commonly performed surgical procedures. Femoral neck fracture (FNF) and osteoarthritis (OA) are two of the medical conditions necessitating a hip replacement, most frequently carried out. The preoperative and postoperative pathways for patients suffering from these two diseases differ, yet worldwide, many national healthcare systems underestimate or misinterpret the (more than nuanced) care plan differences of the two. Factors and Criteria. Analyzed material was gathered from studies published between 2013 and 2019. Various strands of data demographics, comorbidities, and complications, as well as treatment outcomes, were tabulated to compare and contrast THA patients suffering from FNF and OA to collate their findings. Outcomes were cross-checked and validated for reliability and then were presented in a table format.
Results:
All five retrospective cohort studies fitted the required criteria for inclusion in this work, four US-based study groups and one European-based study group. Data were gathered from three separate databases. The "average" FNF patient is 76.8 years old. There was a 68.96% female probability. The "average" OA patient is 69.15 years old. There was a 5.24% female probability. 59.57% operated for athrosis, and only 34.63% operated for fracture which received grade lower than the third in the American Society of Anaesthesiologist (ASA) classification. There was more than 3 times higher prevalence of complications in the trauma group. FNF patients' hospitalization was approximately 3 days longer. On average, 3.7% of patients operated for trauma and 1.5% of patients with elective THA required a second surgery. 6.57% FNF and 2.93% OA patients had unplanned readmission.
Conclusions:
In general, patients who suffer a femoral neck fracture are an extremely fragile group. They require additional perioperative and postoperative care. To meet these desired expectations, more FNF cost-comprehensive systems need to be initiated.
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