#2542 - Clinical Study / Free Papers

Arthroplasty Can Improve Long-Term Survival Of Female Patients Sustained

Femoral Neck Fractures Age Over Ninety: The 10 Years Results Of Compare
Operative To Non-Operative
Trauma / Hip & Femur Trauma / Surgical Treatment

Yang Liu, Tian-Fu Yang

West China Hospital of Sichuan University, Chengdu, China

Keywords: Nonagenarian, Femoral Neck Fracture, Long-Term Survival,Arthroplasty,Conservative

Treatment

Background
China is one of the five countries with the largest number of persons aged 80 or over. By the end of
2017, China’s population of age over 90 years reached 3.053 million, accounting for 14.97% of the
same age group of world total population. With life expectancy increases and incidence of hip fractures
increasing, the number of nonagenarian and centenarians sustaining these fractures in China is also
increasing. The optimal treatment of femoral neck fractures in nonagenarian patients continues to be
debated. Moreover, there is a lack of data reflecting the short and long-term outcome of nonagenarian
patients suffering femoral neck fracture in a China context.
Objectives
The main purpose of this retrospective study was to compare and evaluate the short and long-term
mortality between operative and non-operative treatment of patients age over 90 years with femoral
neck fracture during the same 10 -year period. The second aim is to analyze the influence of gender
difference on the mortality of femoral neck fracture patients.
Study Design & Methods
From January 2007 to December 2016, all consecutive nonagenarian and centenarian patients with
femoral neck fracture admitted to our hospital were evaluated for eligibility. End of follow-up was
defined as the date of death or emigration, or 30 August 2018, whichever came first, and survival was
determined at this time. According to the different treatment regimes (conservative group versus
arthroplasty), we divided the patients into the Conservative group and Arthroplasty group. The primary
outcome was defined as thirty-day mortality, 1-year,2-year, 3-year, 4-year and 5-year mortality after
injury. Survival analysis was performed by the Kaplan–Meier method for all-cause mortality. Using the
log-rank (Mantel-Cox) test, the stratified analyses by gender (male and female), Arthroplasty group and
conservative group, were performed to compare the difference of survival distributions.
Results
First and foremost finding is that the arthroplasty procedure can improve not only the short and
long-term cumulative survival of femoral neck fracture patients age above 90s. The mean survival time
after injury of arthroplasty group was significantly higher than the conservative group (64.3 months
versus 33.9months, 95% CI 46.394-82.214 versus 25.659-42.210, P=0.008 ). The gender difference of
survival distributions between the arthroplasty group and the conservative group is significant for
women (P=0.002, <0.05), but not for men (P=0.622).The last key aspect of our study is that the peak of
annual mortality of conservative group was seen in the first year after injury (26.9%), and retained at a
stable level of less than 20% during the next 2-5 years.
Conclusions
The strengths of this study are the data collection and the duration of follow-up, which more than ten
years, is the longest of any published series and exceeds the life expectancy for this age group.
Meanwhile, this is the first series to assess short and long-term survival after femoral neck fracture for
china patients age over ninety. The arthroplasty procedure can improve the short and long-term survival
of femoral neck fracture patients age above 90s, especially for women. Arthroplasty treatment in the
extreme elderly should not be discounted on the grounds of age alone. It can be anticipated that almost
two third of the patients will survive more than five years after surgery. These findings could profitably
the research for the real cause of gender difference of the nonagenarian and centenarian patients
sustaining the hip fracture.