Predicting Functional Outcomes in Patients with Femoral Neck Fractures Treated by Hemiarthroplasty.

BACKGROUND: A femoral neck fracture leads to serious health-related, social and economic consequences and, according to the con-temporary doctrine of medical management, should be treated surgically. Data provided by the Agency for Health Technology Assessment and Tariff System indicate that there were 1534 patients with femoral neck fractures treated by arthroplasty with a Moore's endoprosthesis and 4744 with a bipolar endoprosthesis in Poland in 2014. Since the risk of femoral neck fracture increases exponentially with the patient's age, and population aging is undoubtedly a real demographic trend, we believe that there is a need to develop criteria for taking treatment decisions to ensure the best possible outcomes. The aim of this paper is to identify factors influencing the functional outcomes of hemiarthroplasty measured with the Harris Hip Score (HHS) in patients with femoral neck fractures.

MATERIAL AND METHODS: The first part of study data consisted of clinical data derived from the medical treatment records of 161 patients with femoral neck fractures who were treated by hemiarthroplasty in the Orthopaedic Department of the Regional Hospital in Sieradz in 2009-2011. The age, sex, overall health status of the patients qualified for surgical treatment, time between injury and surgery, type of endoprosthesis, and length of stay at the department were determined. The second part was data from an outcome assessment using the Harris Hip Score (HHS) at two-year follow-up visits of 90 patients of the original group.

RESULTS: The mean outcome of all the patients was defined as satisfactory (HHS score of 73.37 points). Examination of one-factor correlations between the outcome and the patient's sex and the type of endoprosthesis revealed significantly superior outcomes in men and patients who received the bipolar endoprosthesis. A multiple factor statistical analysis, which additionally included the variables of patient age and baseline overall health status, demonstrated that only overall health status (ASA score) had a statistically significant effect on the functional outcome of arthroplasty among all factors examined.

CONCLUSIONS: 1. Evaluation of the quality of life of patients who underwent surgery after femoral neck fractures utilising the Harris Hip Score (HHS) in one-fac-tor correlations (age, sex, type of endoprosthesis, general condition) revealed significantly superior results for men who received the bipolar endo-prosthesis. There was also a moderately strong and negative correlation with the patients' age. 2. The functional outcomes in patients with low energy femoral neck fractures treated with two types of partial hip endoprosthesis at the Ortho-paedic Department of the Regional Hospital in Sieradz, assessed by multiple factor analysis, showed a significant correlation only with the patient's baseline overall health status.