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Implant Removal After Internal Fixation of a Femoral Neck Fracture: Effects on Physical Functioning

Zielinski, Stephanie M. MD*; Heetveld, Martin J. MD, PhD; Bhandari, Mohit MD, PhD; Patka, Peter MD, PhD§; Van Lieshout, Esther M. M. MSc, PhD*on behalf of the FAITH Trial Investigators

doi: 10.1097/BOT.0000000000000358
Original Article

Objectives: The effect of implant removal after internal fixation of a femoral neck fracture on physical functioning was analyzed. Characteristics of patients who had their implant removed were studied, as it is currently unknown from which type of patients implants are removed and what effect removal has on function.

Design: Secondary cohort study alongside a randomized controlled trial.

Setting: Multicenter study in 14 hospitals.

Patients and Intervention: Patients who had their implant removed after internal fixation of a femoral neck fracture are compared with patients who did not.

Main outcome measurements: Patient characteristics and quality of life (Short Form 12, Western Ontario McMaster Osteoarthritis Index) were compared. Matched pairs were selected based on patient/fracture characteristics and prefracture physical functioning.

Results: Of 162 patients, 37 (23%) had their implant removed. These patients were younger (median age: 67 vs. 72 years, P = 0.024) and more often independently ambulatory prefracture (100% vs. 84%, P = 0.008) than patients who did not. They more often had evident implant back-out on x-rays (54% vs. 34%, P = 0.035), possibly related to a higher rate of Pauwels 3 fractures (41% vs. 22%, P = 0.032). In time, quality of life improved more in implant removal patients [+2 vs. −4 points, Short Form 12 (physical component), P = 0.024; +9 vs. 0 points, Western Ontario McMaster Osteoarthritis Index, P = 0.019].

Conclusions: Implant removal after internal fixation of a femoral neck fracture positively influenced quality of life. Implant removal patients were younger and more often independently ambulatory prefracture, more often had a Pauwels 3 fracture, and an evident implant back-out. Implant removal should be considered liberally for these patients if pain persists or functional recovery is unsatisfactory.

Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Supplemental Digital Content is Available in the Text.

*Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands;

Department of Surgery, Kennemer Gasthuis, Haarlem, the Netherlands;

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; and

§Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

Reprints: Esther M. M. Van Lieshout, MSc, PhD, Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: e.vanlieshout@erasmusmc.nl).

Members of the research team received a grant from Fonds NutsOhra (Grant Number T-0602-43), the Netherlands Organization for Health Research and Development (ZonMw; Grant Number 171102008), Physicians' Services Incorporated Foundation (Grant Number 08–18), and Canadian Institutes of Health Research (Grant Number 177466).

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

The FAITH trial investigators are listed in Appendix 1.

Accepted April 29, 2015

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