Patient satisfaction, pain, and quality of life 4 months after displaced femoral neck fractures: A comparison of 663 fractures treated with internal fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register

Figures & data

Figure 1. Flow chart of the study.

Table 1.  Baseline characteristics of patients

	Internal fixation	Hemiarthroplasty	P-value
Total no.	663	906
Mean age (min–max)(SD)	82.0 (70–99) (6.5)	82.6 (70–100) (5.9)	< 0.001^a
Sex (% female)	75	81	0.004^b
ASA score
ASA 1 Healthy	64 (9.9%)	84 (9.5%)
ASA 2 Mild, systemic disease	266 (41%)	398 (45%)
ASA 3 Severe, systemic disease	284 (44%)	373 (42%)
ASA 4 Incapacitating disease	34 (5.2%)	30 (3.4 %)
ASA 5 Moribund	2 (0.3%)	1 (0.1%)	0.35^b
Cognitive impairment (%)	16	14	0.2 b^b
Preoperative delay (h) (min–max)(SD)^c	18.2 (3–225) (17.7)	27.9 (2–556) (36.1)	< 0.001^a
Preoperative EQ-5D index score	0.68	0.69	0.45^a

^a Independent samples t-test.

^b Pearson chi-square test.

^c 1 patient in the hemiarthroplasty group with a preoperative delay of 5 months is excluded.

Table 2.  Types of implants

Internal fixation		Hemiarthroplasty
Name	n (%)	Name	n (%)
Olmed	391 (59)	Charnley – cemented bipolar	279 (31)
Richards CHP	141 (21)	Exeter/V40 – cemented bipolar	195 (22)
LIH nail	99 (15)	Corail – uncemented bipolar^a	148 (16)
Asnis III	32 (4.8)	Titan – cemented bipolar	108 (12)
		Spectron – cemented bipolar	85 (9.4)
		Other/missing	91 (10)

^aHydroxyapatite-coated.

Table 3.  Pain and satisfaction with the result of the operation, derived 4 months postoperatively from visual analog scales (VAS)

	Internal fixation		Hemiarthroplasty		P-value^c
	Mean (SE)	95% CI	Mean (SE)	95% CI	GLM
A. All patients (intention-to-treat analysis)
Pain^a	41 (2.5)	36–46	27 (2.6)	22–32	< 0.001
Satisfaction with the result^b	48 (2.7)	42–53	33 (2.7)	27–38	< 0.001
B. Reoperated patients excluded
Pain^a	40 (2.5)	35–45	28 (2.5)	23–33	< 0.001
Satisfaction with the result^b	47 (2.6)	42–52	33 (2.6)	28–38	< 0.001

^a Pain: the value 0 means no pain and the value 100 means unbearable pain.

^b Satisfaction: the value 0 means satisfied and the value 100 means dissatisfied.

^c p-value is the probability of no difference between the two treatment groups (general linear models (GLMs) adjusted for differences in age, sex, cognitive impairment, ASA class, and preoperative delay of surgery between the groups).

Figure 2. The degree of pain derived from a visual analog scale (VAS) 4 months postoperatively. The figure shows the distribution of pain for the 2 different treatment groups. 0 indicates no pain and 100 indicates unbearable pain.

Figure 3. The degree of satisfaction with the result of the operation, derived from a visual analog scale (VAS) 4 months postoperatively. The figure shows the distribution of patient satisfaction for the 2 different treatment groups. 0 indicates very satisfied and 100 indicates very dissatisfied.

Figure 4. Health-related quality of life (EQ-5D index score) for patients at 0 and 4 months. 0 indicates the worst possible health state and 1.0 indicates full health. The p-values are given for differences between the treatment groups (general linear model).

Table 4.  Quality of life (EQ-5D) for patients operated with internal fixation or bipolar hemiarthroplasty

	Before operation			4 months postoperatively
	Internal fixation	Hemi-arthroplasty	P-value^a	Internal fixation	Hemi-arthroplasty	P-value^a
Mobility
No problems in walking about	333 (52%)	464 (52%)		54 (8.4%)	162 (18%)
Some problems in walking about	308 (48%)	418 (47%)		525 (81%)	669 (75%)
Confined to bed	4 (0.6%)	6 (0.7%)	0.96	66 (10%)	57 (6.4%)	< 0.001
Self-care
No problems with self-care	418 (65%)	608 (68%)		200 (31%)	358 (40%)
Some problems with self-care	171 (27%)	218 (24%)		293 (46%)	380 (43%)
Unable to wash or dress	52 (8.1%)	68 (7.6%)	0.51	148 (23%)	156 (17%)	0.001
Usual activities
No problems in performing usual activities	300 (46%)	407 (46%)		77 (12%)	163 (18%)
Some problems in performing usual activities	240 (37%)	347 (40%)		314 (49%)	449 (51%)
Unable to perform usual activities	106 (16%)	132 (15%)	0.62	255 (40%)	274 (31%)	< 0.001
Pain/discomfort
No pain or discomfort	368 (57%)	514 (58%)		106 (16%)	284 (32%)
Moderate pain or discomfort	239 (37%)	331 (37%)		422 (65%)	530 (60%)
Extreme pain or discomfort	41 (6.3%)	40 (4.5%)	0.29	120 (19%)	71 (8.0%)	< 0.001
Anxiety/depression
Not anxious or depressed	413 (64%)	568 (64%)		317 (49%)	456 (51%)
Moderately anxious or depressed	198 (31%)	272 (31%)		282 (44%)	364 (41%)
Extremely anxious or depressed	33 (5.1%)	51 (5.7%)	0.88	45 (7.0%)	71 (8.0%)	0.47
^aPearson chi-square test.