Fresh Unstable Trochanteric Fracture in Elderly Patients: Mortality, Readmission and Reoperation After Primary Hemiarthroplasty

Abstract Objectives: Most unstable trochanteric fractures are treated with internal fixation often with high complication rates. Hemiarthroplasty is an alternative treatment to achieve early weight-bearing, early mobilization and acceptable functional outcomes. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We investigated patients with fresh trochanteric fracture after primary hemiarthroplasty on their long-term outcomes, including mortality, readmission and reoperation.Methods: We studied a total of 2,798 elderly adults who had received hemiarthroplasty for fresh unstable trochanteric fracture from 2000 to 2010, and followed them up until the end of 2012. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation.Results: The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male, older age, larger CCI and lower insured amount were all risk factors for the overall mortality. Older age and larger CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death.Conclusion: Results are consistent with hemiarthroplasty being a robust alternative treatment for unstable trochanteric fracture among a heterogeneous elderly population.