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Quality of life after dislocation of hip arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up

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Abstract

Purpose

A primary arthroplasty constitutes a standard procedure in the treatment of patients with displaced fractures of the femoral neck. Although dislocation of the prosthesis remains a significant clinical problem, there are no previous reports on its influence on health-related quality of life (HRQoL). We analysed how a dislocation of the hip arthroplasty influenced the patients’ HRQoL.

Methods

In total 319 consecutive patients with a displaced fracture of the femoral neck treated with a primary arthroplasty were included in a prospective cohort study. We used a mixed-effects model regression analysis to evaluate factors of importance for HRQoL (EQ-5Dindex score) during the first 12 months following surgery.

Results

A dislocation of the arthroplasty occurred in 21 of the 319 patients (7%), 8 of whom had a single dislocation and 13 recurrent dislocations. At 4 months, the EQ-5Dindex score displayed a significantly worse outcome for patients with recurrent dislocations compared to patients with no dislocation (P = 0.001), and a trend towards a worse outcome for patients with a single dislocation (P = 0.08). At 12 months, the mean EQ-5Dindex score of patients with recurrent dislocations was still substantially lower (P = 0.001), while the EQ-5Dindex score for patients with a single dislocation had returned to a level similar to that of patients with no dislocation. Our analysis of the EQ-5D dimensions indicates that the difference was mainly due to perceived difficulties in self-care and usual activities and increased problems with anxiety/depression.

Conclusions

A recurrent dislocation of the hip arthroplasty in the treatment of patients with femoral neck fractures seems to result in a persisting deterioration in the HRQoL, while patients with a single dislocation seem to experience only a temporary deterioration.

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Abbreviations

ASA:

American society of anaesthesiologists

EQ-5D:

EuroQol-5 dimensions

HA:

Hemiarthroplasty

HRQoL:

Health-related quality of life

THR:

Total hip replacement

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Acknowledgments

Special thanks to the Stockholm Hip Fracture Group: Paul Ackerman, Amer Al-Ani, Richard Blomfeldt, Tommy Cederholm, Margareta Hedström, Paula Kelly-Pettersson, Kristina Källbom, Gustaf Neander, Åsa Norling, Eva Samnegård, Bodil Samuelsson, Anita Söderqvist, Maria Sääf and K.-G. Thorngren. We also wish to thank Buster Mannheimer, Department of Clinical Science and Education, Section for Internal Medicine, Stockholm Söder Hospital, for the help in the early design of the statistical model.

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Authors and Affiliations

  1. Karolinska Institutet, Department of Clinical Science and Education, Section for Orthopaedics, Stockholm Söder Hospital, 118 83, Stockholm, Sweden

    Anders Enocson, Sari Ponzer, Hans Törnkvist & Jan Tidermark

  2. Karolinska Institutet, Department of Clinical Science and Education, Statistics Section, Stockholm Söder Hospital, Stockholm, Sweden

    Hans Pettersson

  3. Karolinska Institutet, Department of Clinical Science and Education, Section for Orthopaedics, Danderyd Hospital, Stockholm, Sweden

    Nils Dalén

  4. Department of Orthopaedics, Capio S:t Görans Hospital, Stockholm, Sweden

    Jan Tidermark

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  1. Anders Enocson
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  2. Hans Pettersson
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  3. Sari Ponzer
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  4. Hans Törnkvist
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Correspondence to Anders Enocson.

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Enocson, A., Pettersson, H., Ponzer, S. et al. Quality of life after dislocation of hip arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up. Qual Life Res 18, 1177–1184 (2009). https://doi.org/10.1007/s11136-009-9531-x

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