Clinical results after hip fracture - with special focus on hip arthroplasty

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

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Sammanfattning

Hip fractures are of major concern worldwide, but even if literature is
abundant, there are still gaps to fill. The global outcome needs to be better
understood, including patient-reported outcome. Many studies focus on
improving surgical outcome, with less focus on medical complications. The
true number of adverse events after hip fracture surgery is unknown. Femoral
neck fractures (FNFs), constituting half of all hip fractures, are commonly
treated with arthroplasty, but evidence on whether to use hemiarthroplasty
(HA) or total hip arthroplasty (THA) is unclear.

Paper I is a retrospective cohort study of all patients with hip fracture at our
hospital during one year, examining complications and patient-reported
outcome. Absence of medical and hip complications correlated to improved
satisfaction and pain. Medical complications alone correlated to loss of
function. One-third regained pre-fracture mobility and one-third received
enough rehabilitation.

Paper II is an observational cohort study comparing two matched groups of
patients with THA or HA as treatment for FNF. THA had significantly reduced
risk of revision and reoperation, and was associated with reduced mortality.

Papers III and IV are observational cohort studies on patients treated with THA
or HA for FNF, with adjustment for comorbidity and socioeconomic
background. A majority suffered an adverse event, one-third suffered a
medical complication and one-fifth a hip complication. THA was associated
with fewer medical complications and lower mortality but more hip
complications, even after matching according to comorbidity and
socioeconomic variables.

In conclusion, complications are important for outcome and improving the
overall care of hip fracture patients is as important as the choice of surgical
treatment. THA may perform better than HA in some aspects in selected
patients, but an unbiased comparison between the two types of arthroplasties
is difficult to achieve.
Originalspråkengelska
KvalifikationDoktor
Tilldelande institution
  • Institutionen för kliniska vetenskaper, Malmö
Handledare
  • Rogmark, Cecilia, handledare
  • Åkesson, Kristina, Biträdande handledare
  • Kärrholm, Johan, Biträdande handledare, Extern person
Tilldelningsdatum2018 nov. 23
UtgivningsortLund
Förlag
ISBN (tryckt)978-91-7619-702-8
StatusPublished - 2018

Bibliografisk information

Defence details
Date: 2018-11-23
Time: 09:00
Place: Lilla aulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö
External reviewer(s)
Name: Sayed-Noor, Arkan
Title: associate professor
Affiliation: Umeå University

Ämnesklassifikation (UKÄ)

  • Medicin och hälsovetenskap

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