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

Stephanie M Zielinski; Martin J Heetveld; Mohit Bhandari; Peter Patka; Esther M M Van Lieshout; FAITH Trial Investigators

doi:10.1097/BOT.0000000000000358

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

J Orthop Trauma. 2015 Sep;29(9):e285-92. doi: 10.1097/BOT.0000000000000358.

Authors

Stephanie M Zielinski¹, Martin J Heetveld, Mohit Bhandari, Peter Patka, Esther M M Van Lieshout; FAITH Trial Investigators

Collaborators

FAITH Trial Investigators:
Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Trevor Stone, Darius Viskontas, H Michael Lemke, Mauri Zomar, Karyn Moon, Raely Moon, Amber Oatt, Richard E Buckley, Paul Duffy, Robert Korley, Shannon Puloski, Kelly Johnston, James Powell, Kimberly Carcary, David Sanders, Abdel Lawendy, Christina Tieszer, David Stephen, Hans Kreder, Richard Jenkinson, Markku Nousiainen, Terry Axelrod, John Murnaghan, Diane Nam, Veronica Wadey, Albert Yee, Katrine Milner, Monica Kunz, Emil H Schemitsch, Henry Ahn, Jeremy A Hall, Michael D McKee, Daniel B Whelan, Aaron Nauth, Milena R Vicente, Lisa M Wild, Ryan M Khan, Jennifer T Hidy, Chad Coles, Ross Leighton, Michael Biddulph, David Johnston, Mark Glazebrook, David Alexander, Cathy Coady, Michael Dunbar, David Amirault, Michael Gross, William Oxner, Gerald Reardon, Glen Richardson, Andrew Trenholm, Ivan Wong, Kelly Trask, Shelley MacDonald, Gwen Dobbin, Ryan Bicknell, Jeff Yach, Davide Bardana, Gavin Wood, Mark Harrison, David Yen, Sue Lambert, Fiona Howells, Angela Ward, Paul Zalzal, Heather Brien, V Naumetz, Brad Weening, Nicole Simunovic, Eugene K Wai, Steve Papp, Wade T Gofton, Allen Liew, Stephen P Kingwell, Garth Johnson, Joseph O'Neil, Darren M Roffey, Vivian Borsella, Victoria Avram, Todd M Oliver, Vicki Jones, Clifford B Jones, James R Ringler, Terrence J Endres, Samuel G Agnew, Debra L Sietsema, Jane E Walker, Kyle J Jeray, J Scott Broderick, David R Goetz, Thomas B Pace, Thomas M Schaller, Scott E Porter, Stephanie L Tanner, Rebecca G Snider, Lauren A Nastoff, Shea A Bielby, Julie A Switzer, Peter A Cole, Sarah A Anderson, Paul M Lafferty, Mengnai Li, Thuan V Ly, Scott B Marston, Amy L Foley, Sandy Vang, David M Wright, Andrew J Marcantonio, Michael S H Kain, Richard Iorio, Lawrence M Specht, John F Tilzey, Margaret J Lobo, John S Garfi, Heather A Vallier, Andrea Dolenc, Chalitha Robinson, Michael J Prayson, Richard Laughlin, L Joseph Rubino, Jedediah May, Geoffrey Ryan Rieser, Liz Dulaney-Cripe, Chris Gayton, James Shaer, Tyson Schrickel, Barbara Hileman, John T Gorczyca, Jonathan M Gross, Catherine A Humphrey, Stephen Kates, Krista Noble, Allison W McIntyre, Kaili Pecorella, Craig A Davis, Stewart Weinerman, Peter Weingarten, Philip Stull, Stephen Lindenbaum, Michael Hewitt, John Schwappach, Janell K Baker, Tori Rutherford, Heike Newman, Shane Lieberman, Erin Finn, Kristin Robbins, Meghan Hurley, Lindsey Lyle, Khalis Mitchell, Kieran Browner, Erica Whatley, Krystal Payton, Christina Reeves, Lisa K Cannada, David Karges, Leslie Hill, Samir Mehta, John Esterhai, Jaimo Ahn, Annamarie D Horan, Kelly McGinnis, Christine A Kaminski, Brynn N Kowalski, Jonathan P Keeve, Christopher G Anderson, Michael D McDonald, Jodi M Hoffman, Ivan Tarkin, Peter Siska, Gary Gruen, Andrew Evans, Dana J Farrell, James Irrgang, Arlene Luther, William W Cross 3rd, Joseph R Cass, Stephen A Sems, Michael E Torchia, Tyson Scrabeck, Mark Jenkins, Jules Dumais, Amanda W Romero, Carlos A Sagebien, Mark S Butler, James T Monica, Patricia Seuffert, Joseph R Hsu, James Ficke, Michael Charlton, Matthew Napierala, Mary Fan, Paul Tornetta 3rd, Chadi Tannoury, Hope Carlisle, Heather Silva, Michael Archdeacon, Ryan Finnan, Toan Le, John Wyrick, Shelley Hess, Michael L Brennan, Robert Probe, Evelyn Kile, Kelli Mills, Lydia Clipper, Michelle Yu, Katie Erwin, Daniel Horwitz, Kent Strohecker, Teresa K Swenson, Andrew H Schmidt, Jerald R Westberg, Kamran Aurang, Gary Zohman, Brett Peterson, Roger B Huff, Joseph Baele, Timothy Weber, Matt Edison, Jessica McBeth, Karl Shively, Janos P Ertl, Brian Mullis, J Andrew Parr, Ripley Worman, Valda Frizzell, Molly M Moore, Erin Tobias, Emily Thomas, Charles J DePaolo, Rachel Alosky, Leslie E Shell, Lynne Hampton, Stephanie Shepard, Tracy Nanney, Claudine Cuento, Robert V Cantu, Eric R Henderson, Linda S Eickhoff, E Mark Hammerberg, Philip Stahel, David Hak, Cyril Mauffrey, Douglas Gibula, Hannah Gissel, Corey Henderson, David P Zamorano, Martin C Tynan, Deeba Pourmand, Deanna Lawson, Gregory J Della Rocca, Brett D Crist, Yvonne M Murtha, Linda K Anderson, Colleen Linehan, Lindsey Pilling, Courtland G Lewis, Stephanie Caminiti, Raymond J Sullivan, Elizabeth Roper, William Obremskey, Philip Kregor, Justin E Richards, Kenya Stringfellow, Michael P Dohm, Abby Zellar, Michiel J M Segers, Jacco A C Zijl, Bart Verhoeven, Anke B Smits, Jean Paul P M de Vries, Bram Fioole, Henk van der Hoeven, Evert B M Theunissen, Tammo S de Vries Reilingh, Lonneke Govaert, Philippe Wittich, Maurits de Brauw, Jan Wille, Peter M N Y M Go, Ewan D Ritchie, Ronald N Wessel, Eric R Hammacher, Martin J Heetveld, Gijs A Visser, Heyn Stockmann, Rob Silvis, Jaap P Snellen, Bram Rijbroek, Joris J G Scheepers, Erik G J Vermeulen, Michiel P C Siroen, Ronald Vuylsteke, Hans L F Brom, Herman Rijna, Piet A R de Rijcke, Cees L Koppert, Steven E Buijk, Richard P R Groenendijk, Imro Dawson, Geert W M Tetteroo, Milko M M Bruijninckx, Pascal G Doornebosch, Eelco J R de Graaf, Maarten van der Elst, Carmen C van der Pol, Martijne van't Riet, Tom M Karsten, Mark R de Vries, Laurents P S Stassen, Niels W L Schep, G Ben Schmidt, W H Hoffman, Reinier de Graaf Gasthuis, Rudolf W Poolman, Maarten P Simons, Frank H W M van der Heijden, W Jaap Willems, Frank R A J de Meulemeester, Cor P van der Hart, Kahn Turckan, Sebastiaan Festen, Frank de Nies, Robert Haverlag, Nico J M Out, Jan Bosma, Albert van Kampen, Jan Biert, Arie B, Michael J R Edwards, Taco J Blokhuis, Jan Paul, M Frölke, Leo M G Geeraedts, Jean W M Gardeniers, Edward T C H Tan, Lodewijk M S J Poelhekke, Maarten C de Waal Malefijt, Bart Schreurs, Gert R Roukema, Hong A Josaputra, Paul Keller, Peter D de Rooij, Hans Kuiken, Han Boxma, Berry I Cleffken, Ronald Liem, Steven J Rhemrev, Coks H R Bosman, Alexander de Mol, van Otterloo, Jochem Hoogendoorn, Alexander C de Vries, Sven A G Meylaerts, Michiel H J Verhofstad, Joost Meijer, Teun van Egmond, Frank H W M van der Heijden, Igor van der Brand, Elisabeth Ziekenhuis, Peter Patka, Martin G Eversdijk, Rolf Peters, Dennis Den Hartog, Oscar J F Van Waes, Pim Oprel, Harm M van der Vis, Martin Campo, Ronald Verhagen, G H Robert Albers, Arthur W Zurcher, Rogier K J Simmermacher, Jeroen van Mulken, Karlijn van Wessem, Taco J Blokhuis, Steven M, van Gaalen, Luke P H Leenen, Maarten W G A Bronkhorst, Onno R Guicherit, J Carel Goslings, Robert Haverlag, Kees Jan Ponsen, Mahesh Bhatia, Vinod Arora, Vivek Tyagi, Susan Liew, Harvinder Bedi, Ashley Carr, Hamish Curry, Andrew Chia, Steve Csongvay, Craig Donohue, Stephen Doig, Elton Edwards, Greg Etherington, Max Esser, Andrew Gong, Arvind Jain, Doug Li, Russell Miller, Ash Moaveni, Matthias Russ, Lu Ton, Otis Wang, Adam Dowrick, Zoe Murdoch, Claire Sage, Frede Frihagen, John Clarke-Jenssen, Geir Hjorthaug, Torben Ianssen, Asgeir Amundsen, Jan Egil Brattgjerd, Tor Borch, Berthe Bøe, Bernhard Flatøy, Sondre Hasselund, Knut Jørgen Haug, Kim Hemlock, Tor Magne Hoseth, Geir Jomaas, Thomas Kibsgård, Tarjei Lona, Gilbert Moatshe, Oliver Müller, Marius Molund, Tor Nicolaisen, Fredrik Nilsen, Jonas Rydinge, Morten Smedsrud, Are Stødle, Axel Trommer, Stein Ugland, Anders Karlsten, Guri Ekås, Elise Berg Vesterhus, Anne Christine Brekke, Ajay Gupta, Neeraj Jain, Farah Khan, Ateet Sharma, Amir Sanghavi, Mittal Trivedi, Anil Rai, Kamal Rai, Vineet Yadav, Sanjay Singh, Kamal Rai, Kevin Tetsworth, Geoff Donald, Patrick Weinrauch, Paul Pincus, Steven Yang, Brett Halliday, Trevor Gervais, Michael Holt, Annette Flynn, Amal Shankar Prasad, Vimlesh Mishra, D C Sundaresh, Angshuman Khanna, Joe Joseph Cherian, Davy J Olakkengil, Gaurav Sharma, Marinis Pirpiris, David Love, Andrew Bucknill, Richard J Farrugia, Hans-Christoph Pape, Matthias Knobe, Roman Pfeifer, Peter Hull, Sophie Lewis, Simone Evans, Rajesh Nanda, Rajanikanth Logishetty, Sanjeev Anand, Carol Bowler, Akhil Dadi, Naveen Palla, Utsav Ganguly, B Sachidananda Rai, Janakiraman Rajakumar, Andrew Jennings, Graham Chuter, Glynis Rose, Gillian Horner, Callum Clark, Kate Eke, Mike Reed, Chris Herriott, Christine Dobb

Affiliation

¹ *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.

PMID: 26165264
DOI: 10.1097/BOT.0000000000000358

Abstract

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.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Arthralgia / diagnosis
Arthralgia / epidemiology
Arthralgia / prevention & control*
Cohort Studies
Device Removal / statistics & numerical data*
Female
Femoral Neck Fractures / epidemiology
Femoral Neck Fractures / surgery*
Fracture Fixation, Internal / instrumentation
Fracture Fixation, Internal / statistics & numerical data*
Humans
Internal Fixators / statistics & numerical data
Male
Middle Aged
Motor Activity*
Netherlands / epidemiology
Prevalence
Quality of Life*
Risk Factors
Treatment Outcome

Grants and funding

177466/Canadian Institutes of Health Research/Canada