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- Title
Survivability of the Femoral Neck System for the treatment of femoral neck fractures in adults.
- Authors
Stegelmann, Samuel D.; Butler, Justin T.; Mathews, Dylan J.; Ostlie, Hunter C.; Boothby, Benjamin C.; Phillips, Seth A.
- Abstract
Introduction: Hip fractures are common injuries in the elderly, with an incidence that continues to rise. The femoral neck system (FNS) recently emerged as a novel treatment option for femoral neck fractures, but long-term survivability of the implant remains uncertain. The purpose of this study is to evaluate survivability of the FNS and assess risk factors for implant failure. Methods: One hundred five adult patients who received the FNS (DePuy Synthes, Raynham, MA) for femoral neck fractures (AO/OTA 31B) were included. Surgeries were performed within a regional hospital system comprising 18 facilities. All patients had a minimum follow-up of 1 year. The primary outcome measures were cumulative incidence of implant failure and 1-year mortality, including risk factor analysis. Results: Twelve implants failed at a follow-up ranging from 17 days to 8 months, and 7 failed within 90 days. Cumulative incidence of implant failure was 2% at 30 days, 7% at 90 days, 12% at 6 months, and 13% at 1 year. Causes of implant failure included cut-out (n = 5), non-union (n = 4), peri-implant fracture (n = 2), and avascular necrosis (n = 1). Univariate Cox regression identified Pauwels type III fractures and an increasing AP Parker ratio as significant risk factors for failure. Pauwels type III fractures showed a 5.48 times higher risk compared to Pauwels types I & II. Every 10% increase in AP Parker ratio increased risk of failure by 2.39 times. The 1-year mortality rate was 21%, and univariate logistic regression identified age as the only risk factor (odds ratio = 3.71). Conclusions: The incidence of implant failure and 1-year mortality rate in this study suggests that the FNS can provide reliable fixation compared to rates in the literature, but complications are not uncommon. Avoiding Pauwels type III fractures and optimizing implant placement appear crucial to preventing implant failure. Level of Evidence: Therapeutic Level IV.
- Subjects
RISK of prosthesis complications; PROSTHETICS; STATISTICS; CONFIDENCE intervals; MORTALITY; RETROSPECTIVE studies; ACQUISITION of data; HEALTH outcome assessment; RISK assessment; MEDICAL records; DESCRIPTIVE statistics; LOGISTIC regression analysis; DATA analysis software; FEMORAL neck fractures; ORTHOPEDIC apparatus; PROPORTIONAL hazards models; OLD age
- Publication
European Journal of Orthopaedic Surgery & Traumatology, 2023, Vol 33, Issue 6, p2555
- ISSN
1633-8065
- Publication type
Article
- DOI
10.1007/s00590-023-03474-5