Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision

Figures & data

Table 1. Baseline characteristics and surgical details of patients with a hip fracture treated with a total hip arthroplasty (THA) or a hemiarthroplasty (HA)

Factor	THA	HA	Missing
	n = 8,155	n = 22,675
Sex, female	70% (5,672/8,141)	70% (15,938/22,644)	45
Age, mean (SD)	71 (9.2)	83 (7.7) ^b	12
ASA, I/II	74% (5,710/7,743)	40% (8,855/22,001) ^b	1,085
Smoking ^a	17% (526/3,170)	8% (729/8,764) ^b	18,896
BMI, mean (SD) ^a	25 (7.3)	24 (9.4) ^b	17,062
Posterolateral approach	60% (4,790/8,046)	53% (11,860/22,462) ^b	322
Uncemented stem fixation	57% (4,584/8,036)	34% (7,578/22,442) ^b	352
Unipolar HA		79% (17,123/21,685)	990

a Smoking and BMI have been registered in the LROI database since 2014.

^bP < 0.001.

Figure 1. Cumulative incidence function (CIF) of revision estimates from competing risks data (1 – survival) for patients treated with HA and THA (n = 30,830).

Table 2. Cumulative incidence function (CIF) estimates from competing risks data (1-survival) for patients treated with HA and THA

Factor	Cumulative incidence of revision
	after 1 year	after 5 years
HA	1.6% (1.4–1.8%)	2.5% (2.3–2.8%)
THA	2.4% (2.0–2.7%)	4.3% (3.8–4.8%)

Table 3. Reasons for revision after hemiarthroplasty (HA) or total hip arthroplasty (THA) for hip fractures

Factor	HA	THA
	n = 501	n = 298
Single reason for revision, n	435	228
Dislocation, n (%)	128 (29)	94 (41)
Peri-prosthetic fracture, n (%)	58 (13)	28 (12)
Infection, n (%)	68 (16)	26 (11)
Loosening of femoral component, n (%)	15 (3)	25 (11)
Loosening of acetabular component or cup/liner wear, n (%)	n/a	18 (8)
Other reasons, n (%)	166 (38)	37 (16)
Multiple of above-mentioned reasons, n	66	70

Table 4. Factors associated with revision in hip fracture patients after hemiarthroplasty (HA) and total hip arthroplasty (THA) in a univariable analysis with a hazard analysis

Factor	HA		THA
	HR	95% CI	HR	95% CI
Sex, female (vs. male)	0.78^b	0.65–0.94	0.61^b	0.48–0.77
Age, ≥ 80 (vs. < 80 years)	0.55^b	0.46–0.65	0.44^b	0.29–0.67
ASA, III–IV (vs. I–II)	0.84	0.70–1.01	1.37^a	1.06–1.76
Smoking, yes (vs. no)	1.40	0.90–2.18	1.70^a	1.02–2.83
Weight, obesity (vs. normal BMI)	0.90	0.67–1.22	1.37	0.86–2.17
Approach, non-posterolateral
(vs. posterolateral)	0.67^b	0.56–0.80	0.68^a	0.54–0.88
Stem fixation, cemented
(vs. uncemented)	0.61^b	0.51–0.73	0.73^a	0.57–0.93
Type of HA, bipolar (vs. unipolar)	0.91	0.73–1.14

HR = hazard ratio.

a P < 0.05

b P < 0.001

Table 5. Factors associated with revision in hip fracture treated with a total hip arthroplasty (THA) or a hemiarthroplasty (HA) in a multivariable approach with hazards model with time-varying covariables

Factor	HA		THA
	HR	95% CI	HR	95% CI
Approach^a, non-posterolateral
(vs. posterolateral)	0.67	0.55–0.81	0.70	0.55–0.90
Stem fixation^a, cemented
(vs. uncemented)	0.63	0.52–0.75	0.71	0.55–0.91
ASA^b, III–IV (vs. I–II)	0.72^d	0.62–0.83	1.46	1.13–1.90
Age^c, ≥ 80 (vs. < 80 years)	0.59^d	0.50–0.70	0.52^d	0.55–0.91
Sex^c, female (vs. male)	0.80	0.66–0.97	0.65	0.51–0.83

HR = hazard ratio.

a Variables with direct effect on outcome.

b Measured confounder with direct effect on choice of HA or THA.

c Measured confounders with effect on ASA.

d Time-varying covariables,

Confounder with direct effect on revision: HA/THA choice (not accounted for by stratification).

Table 6. Reason for revision in factors associated with revision in hip fracture treated with a total hip arthroplasty (THA) or a hemiarthroplasty (HA)

Factor	HA			THA
	Dislocation	Fracture	infection	Dislocation	Fracture	Infection
All	128/435 (29%)	58/435 (13%)	68/435 (16%)	94/228 (41%)	28/228 (12%)	26/228 (11%)
Sex
Male	44/142 (31%)	16/142 (11%)	33/142 (23%)	35/94 (37%)	17/94 (18%)	11/94 (12%)
Female	84/293 (29%)	42/293 (14%)	35/293 (12%)^a	59/134 (44%)	11/134 (8%)^a	15/134 (11%)
Age
< 80 years	53/222 (24%)	19/222 (9%)	27/222 (12%)	81/207 (39%)	26/207 (13%)	25/207 (12%)
≥ 80 years	75/213 (35%)^a	39/213 (18%)^a	41/213 (19%)	13/21 (62%)	2/21 (10%)	1/21 (5%)
ASA
I/II	54/209 (26%)	21/209 (10%)	29/209 (14%)	56/139 (40%)	17/139 (12%)	14/139 (10%)
III/IV	73/208 (35%)^a	34/208 (16%)	38/208 (18%)	32/75 (43%)	10/75 (13%)	12/75 (16%)
Approach
Non-posterolateral	31/165 (19%)	25/165 (15%)	30/165 (18%)	24/74 (32%)	9/74 (12%)	11/74 (15%)
Posterolateral	96/262 (37%)^a	32/292 (12%)	38/262 (15%)	70/152 (46%)	18/152 (12%)	15/152 (10%)
Fixation
Cemented	81/243 (33%)	5/243 (2%)	52/243 (21%)	42/82 (51%)	5/82 (6%)	11/82 (13%)
Uncemented	46/183 (25%)	52/183 (28%)*	16/183 (9%)*	51/142 (36%)^a	22/142 (15%)^a	14/142 (10%)

a P ≤ 0.05.