A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastias

Dennis Sansanovicz; Felipe Caravatto Baras; Rodrigo João Camargo da Silva; David de Mello Marin; Eduardo da Costa Brandão Prota; Luiz Angêlo Vieira; Celso Augusto de Nadalini Simoneti; Edie Benedito Caetano

doi:10.5327/Z1984-4840201626173

Authors

Dennis Sansanovicz - PUC-SP (Pesquisador Voluntário) - USP (Pós-graduando do Programa de Mestrado em Ortopedia e Traumatologia) - HC-FMUSP (Médico Assistente Voluntário do Grupo de Quadril do IOT-HCFMUSP)
Felipe Caravatto Baras Médico Residente em Ortopedia e Traumatologia da PUC-SP
Rodrigo João Camargo da Silva Médico Residente em Ortopedia e Traumatologia da PUC-SP
David de Mello Marin Médico Residente em Ortopedia e Traumatologia da PUC-SP
Eduardo da Costa Brandão Prota Médico Residente em Ortopedia e Traumatologia da PUC-SP
Luiz Angêlo Vieira Professor Assistente da FCMS da PUC-SP
Celso Augusto de Nadalini Simoneti Professor Titular da FCMS da PUC-SP
Edie Benedito Caetano Professor Livre-Docente e Chefe do Departamento de Ortopedia e Traumatologia da FCMS da PUC-SP

DOI:

https://doi.org/10.5327/Z1984-4840201626173

Keywords:

hip fractures, arthroplasty, replacement, hip, fracture fixation, internal, quality of life

Abstract

Introduction: The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surgery in these cases. Conclusion: Further studies are needed to define which is the best surgical treatment option.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biography

Dennis Sansanovicz, - PUC-SP (Pesquisador Voluntário) - USP (Pós-graduando do Programa de Mestrado em Ortopedia e Traumatologia) - HC-FMUSP (Médico Assistente Voluntário do Grupo de Quadril do IOT-HCFMUSP)

Graduação em Medicina pela Pontifícia Universidade Católica de São Paulo. Residência Médica em Ortopedia e Traumatologia na PUC-SP. Título de Especialista em Ortopedia e Traumatologia pela Sociedade Brasileira de Ortopedia e Traumatologia. Membro Títular da Sociedade Brasileira de Ortopedia e Traumatologia - SBOT. Especialização em Cirurgia do Quadril pelo Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP. Membro Titular da Sociedade Brasileira de Quadril - SBQ. Atualmente é aluno de pós-graduação stricto senso (nível Mestrado) no Programa de Ortopedia e Traumatologia da Faculdade de Medicina da USP.

References

Machado AM, Braga ALF, Garcia MLB, Martins LC. Avaliação da qualidade de vida em idosos pós-fratura da extremidade proximal do fêmur. Arq Bras Ciênc Saúde. 2012;37(2):70-5.

Mendonça TMS, Silva CHM, Canto RST, Morales NMO, Pinto RMC, Morales RR. Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric. Clinics. 2008;63(5):607-12.

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13.

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int. 2000;11(8):669-74.

National Clinical Guideline Centre. The management of hip fracture in adults: methods, evidence & guidance [Internet]. London: National Clinical Guideline Centre. 2011 [acesso em 30 set. 2015]. Disponível em: http://www.nice.org.uk/guidance/cg124/evidence/full-guideline-183081997

Osteoporosis New Zealand. Bone Care 2020: a systematic approach to hip fracture care and prevention for New Zealand. Wellington (NZ): Osteoporosis New Zealand; 2012.

Johansen A, Wakeman R, Boulton C, Plant F, Roberts J, Williams A. National Hip Fracture Database: National report 2013. London: Royal College of Physicians; 2013.

Chikude T, Fujiki EN, Honda EK, Ono NK, Milani C. Avaliação da qualidade de vida dos pacientes idosos com fratura do colo do fêmur tratados cirurgicamente pela artroplastia parcial do quadril. Acta Ortop Bras. 2007;15(4):197-9.

Gregory JJ, Kostakopoulou K, Cool WP, Ford DJ. One-year outcome for elderly patients with displaced intracapsular fractures of the femoral neck managed non-operatively. Injury. 2010;41(12):1273-6. doi: 10.1016/j.injury.2010.06.009. Epub 2010 Jul 13.

Hagino H, Nakamura T, Fujiwara S, Oeki M, Okano T, Teshima R. Sequential change in quality of life for patients with incident clinical fractures: a prospective study. Osteoporos Int. 2009;20(5):695-702. doi: 10.1007/s00198-008-0761-5. Epub 2008 Oct 3.

Sakaki MH, Oliveira AR, Coelho FF, Leme LEG, Suzuki I, Amatuzzi MM. Estudo da mortalidade na fratura do fêmur proximal em idosos. Acta Ortop Bras. 2004;12(4):242-9.

Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87(9):2122-30.

Parker MJ, Pryor G, Gurusamy K. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures: a long-term follow-up of a randomised trial. Injury. 2010;41(4):370-3. doi: 10.1016/j.injury.2009.10.003. Epub 2009 Oct 30.

Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J et al. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. 2005;87(8):1680-8.

de Roeck N. A prospective, randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. J Bone Joint Surg Br. 2003;85(3):464-5.

Johansson T. Internal fixation compared with total hip replacement for displaced femoral neck fractures: a minimum fifteen-year follow-up study of a previously reported randomized trial. J Bone Joint Surg Am. 2014;96(6):e46. doi: 10.2106/JBJS.K.00244.

Kamath S. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. J Bone Joint Surg Br. 2004;86(1):148; author reply 148-9.

Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur: 13 year results of a prospective randomised study. Injury. 2000;31(10):793-7.

McKinley JC, Robinson CM. Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg Am. 2002;84-A(11):2010-5.

Sorbie C. Arthroplasty in the treatment of subcapital hip fracture. Orthopedics. 2003;26(3):337-41; quiz 342-3.

Gonçalves Campolina A, Bruscato Bortoluzzo A, Bosi Ferraz M, Mesquita Ciconelli R. Validity of the SF-6D index in Brazilian patients with rheumatoid arthritis. Clin Exp Rheumatol. 2009;27(2):237-45.

Garden RS. Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br. 1964;46:630-47.

Miller BJ, Callaghan JJ, Cram P, Karam M, Marsh JL, Noiseux NO. Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database. J Bone Joint Surg Am. 2014;96(17):e149. doi: 10.2106/JBJS.M.01122.

Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121-9. doi: 10.1097/BOT.0000000000000291.

Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am. 2004;86-A(9):1983-8.

Tidermark J, Zethraeus N, Svensson O, Törnkvist H, Ponzer S. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. 2002. J Orthop Trauma. 2003;17(8 Suppl):S17-S21.

FAITH Investigators. Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures. BMC Musculoskelet Disord. 2014;15:219. doi: 10.1186/1471-2474-15-219.